Application for Inscription

Online form is at the bottom of this page.

Application for inscription onto the Lights on the Hill Truck and Coach Drivers Memorial, is open to persons who have substantially contributed to the Australian Transport Industry who have died in a truck or work related accident, in direct relation to a truck or work related accident, or by other means, or a person who has been a passenger who died in a truck related accident.

To have your loved one added to the wall, please either complete the online application on this page, or download and complete the inscription form and return to Lights on the Hill P.O Box 11304 Centenary Height 4350.

Once applications are received, a member of the Lights on the Hill Trucking Memorial Inc. will contact you to confirm your loved one has been approved to be added to the memorial wall.

As of October 2017 Lights on the Hill Trucking Memorial Inc. requires copies of proof of death for the inscriptee (death certificate, obituary notice or newspaper article) and written proof that the person applying for the inscription is either the direct next of kin, enduring power of attorney, or has written permission that the direct next of kin or executor are aware and approve of the application. Without these methods of proof we will be unable to approve the application. For administration purposes we also require a story about the inscriptee and how they have contributed to the Australian Transport industry. We appreciate if you are also able to submit photos of your loved one so they may be used on our website or Social media pages and can be included in the next publication of “We Won’t Forget You Mate”.

Plaques cost $150 each (once off payment). Once approval of the inscription is confirmed we request that payment be made by either Cheque or Money Order to Lights on the Hill, PO Box 11304, Centenary Heights QLD 4350, or via direct deposit/transfer to Lights on the Hill Trucking Memorial Inc. Heritage Bank Acc # 10728082 (for Heritage bank users only S21), BSB – 638 070.

All forms are to be received before close of business on the 31st of July each year. Plaques will be unveiled at the official Memorial Day which is held on 1st October 2023. Only plaques ordered by Light on the Hill Trucking Memorial Inc. can be mounted on or around the wall. Lights on the Hill committee have the right to accept or reject any application at our discretion.

Application for Inscription

Inscription Details

Surname of Inscriptee *

Given names of Inscriptee *

Nick name of Inscriptee

Home town/city and State *

Date of Birth *

Date of Death *

Death Cert or Obituary Notice *

Maximum file size: 8.39MB

Transport History of Inscriptee *

Inscriptee images

Maximum file size: 8.39MB

Your Details

Name *

Address *

Address

City

State

Postcode

Relationship to Inscriptee *

Proof of Next of Kin Status or NOK approval *

Maximum file size: 8.39MB

Email address *

Home Phone Number *

Mobile Number

Section

Please Note: Applications WILL NOT be processed without proof of next of kin status or written proof of approval from the direct next of kin or executor. In the event that false information is given to Lights on the Hill Trucking Memorial Inc. at the time the application was made, the applicant will be held liable for any costs or legal action taken, and the plaque application will be declined and the plaque may be removed from the memorial wall. Once confirmation that the inscriptee has been approved for placement onto the Memorial wall from Lights on the Hill Trucking Memorial Inc. it is the responsibility of the Applicant to inform the inscriptee's family members of the approved application and details regarding the memorial service.

All care will be taken to see the names and dates are transmitted from this form to the plaque provider by Lights on the Hill Trucking Memorial Inc. In the event an error occurs by us we will rectify that error at our earliest convenience at our expense. We however do not take any responsibility when the error is caused by incorrect information provided to us on this form, and the cost of rectifying the error will be at the cost of the applicant. By ticking this box you acknowledge that you are either the direct Next of Kin or Executor, or you have the written approval from either of those parties who have agreed to provide us with permission for the Inscriptee’s Name, and any relevant details, to appear on the Lights on the Hill Website and/ or Facebook Pages.

Next of Kin Agreement *

I Agree

If the person submitting this Application is not the Next of Kin of the Inscriptee, please provide details of the Next of Kin or Executor and written proof that they have approved and are aware of the application.

Next of Kin

First Name

Surname

Address

City

State

Postcode

Contact Number

Executor/Administrator

First Name

Surname

Address

City

State

Postcode

Contact Number

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Application for Inscription