Below is our Veterans Honoree form.   Please print 2 copies of this page.  Keep one for your records, and mail the other with your payment or payment and photo to:

43rd Memorial Project,  PO Box 7281,  Berlin, CT  06037
Click on Search button on right to see what others have sent in.

Photo should be head & shoulders shot for best reproduction.  Please let us know if you wish your photo to be sent back to you.  We only return photos on request.

If you wish to email your photo, please be sure it is a jpg file extention only.  Photo should be a minimum of 200dpi to insure a sharp photo.  Email photos to: dutch2001@aol.com

Form sent in by:
Name:
Address:
City:
State:
Zip:
Name of Honoree:
Branch of Service:
Hometown:
Campaigns - Activity:
Medals - Awards:
Text with Photo -$25.00:
Text only - $15.00:
Unit / Division:
Phone #
Email: