Benjamin F. Dillingham, III & Bridget Wilson LGBT Veterans Wall of Honor Nomination Form
Please submit this form and all backup information by August 9, 2019 for induction consideration this year.
This section is for information about the person being nominated.
Nominee's Full Name
Branch of Service
U.S. Marine Corps
U.S. Air Force
U.S. Coast Guard
Years in service (ie. 1975-1979)
Type of discharge
Time lived in or served in San Diego
Is candidate living or deceased?
Candidate phone number
Candidate e-mail address
This next section is asking information about the person submitting this nomination form.
Name of nominating individual
Relationship to nominee
Your phone number
Please describe how the nominee meets the nomination requirements (which are listed here:
). Please write this section as if the committee knows nothing about the candidate, and use detail to describe the candidate's contributions to the community. If desired, you may type the response to this section in a separate word processor like Word and paste it here.
Please name the two additional San Diego residents who will serve as co-sponsors of this application.
Items that are separate from this online application (ie. nomination statement, co-sponsor signatures, DD214, etc) should be sent in separately by August 9, 2019 via e-mail to
or post mail to:
c/o David Vance
PO Box 3357
San Diego, CA 92163
Please check-off items you have completed/submitted.
This completed nomination form
Nomination statement (as part of this nomination form)
Signatures of 2 application co-sponsors signed and submitted (find the form here:
Form DD214 (or equivalent). Please not that only the veteran or the veteran's first of kin can get copies of a service member's DD-214 AND that it could take up to a month to receive one. They can be obtained at:
If you are not submitting any piece of the required documentation from the nomination check-list, please note the reason below.
A copy of your responses will be emailed to the address you provided.
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