APPLICATION TO THE VETERAN'S MEMORIAL

Please complete the following information for each name to be included on the honor roll. One name per form please.

Please Print your name and information.

 

__________________________________________________
Name (The way it should appear on plaque)

 

__________________________________________________
Rank - Branch of Service - Service Dates (years)

For Example:
John C. Smith
PVT - U.S. Army - 1945-1947

NOTE: ANY POINTS OF INTEREST CAN BE INCLUDED SUCH AS - KIA, POW,
PURPLE HEART, BRONZE STAR, ETC.

A minimum contribution of $35 per plaque is required, however, any additional contribution to help defray other construction and upkeep costs would be greatly appreciated. Your contribution is Tax Deductible.
Make checks payable to
VETERANS MEMORIAL.

 

Amount included: __________________________

 

Submitted by: _____________________________________
Name

_______________________________________________
Phone Number

Please return this form and payment to Manning VFW hall at:
VFW
201 Main Street
Manning, IA 51455
For more information please call:
712-655-2957