Veteran Name Submission
Please fill out the below information for each veteran's information. This form can be filled out as many times as you need in order to send the information for all veterans. Contact information is for the veteran if living or family if fallen asleep. Veterans and families will be contacted for information about the memorial dedication, so please make sure contact information is current.
Veteran Full Name (Last Name, First Name)
Your answer
Branch of Service
Your answer
Parish
Your answer
Contact Address (include city, state, zip)
Your answer
Your answer
Contact Phone Number
Your answer
Date of Birth
MM
/
DD
/
YYYY
Family Member Name
Your answer
Date of Death (if no longer living)
MM
/
DD
/
YYYY
Family Member Relationship
Your answer
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