NR Wall of Honor application
Please fill out this form as completely as possible, the committee will do its best to verify your application. If you are not comfortable including your SSN then you must mail your DD214 or other proof of service to: NR Wall of Honor P.O.Box 112, New Richmond OH. 45157. If you are filling out an application for someone other than yourself please include any information that may help us confirm their service. If you have specific questions email There is also a pdf available on the site that you can print out and mail if that is your preference. You can also fill out this form and mail in your dd-214 if that is what you prefer.
Branch of Service *
The names will be placed on the wall under the branch of service, so please check the branch under which you want your name to appear. Please only choose one.
First Name *
Your answer
Last Name *
Please put the name you want on the wall. If this is not your maiden name please fill out question 6
Your answer
Middle Initial
Optional, however, full middle names will not be included due to available space.
Your answer
Jr., Sr. III etc...
Your answer
Maiden name for verification purposes
If you are not using your maiden name on the wall please include it here to help us verify your graduation info.
Your answer
Year of graduation. *
Your answer
Proof of service
We are not able to use your SSN so please don't include it. you must mail your DD-214 or other proof of service to NR Wall of Honor, P.O. Box 112, New Richmond, OH 45157. If there is any other information that may help us confirm your service please include it here such as years of service and Unit you were in etc...
Your answer
Contact information
please put your email, home address or phone number if we need to contact you for any reason.
Your answer
Additional Info *
If you have any additional information that may help us verify your service or year of graduation, or if you are nominating someone else please include any additional information here.
Your answer
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