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.
Email address *
This section is for information about the person being nominated.
Nominee's Full Name *
Your answer
Branch of Service *
Years in service (ie. 1975-1979) *
Your answer
Type of discharge *
Your answer
Time lived in or served in San Diego *
Your answer
Is candidate living or deceased? *
Candidate phone number
Your answer
Candidate e-mail address
Your answer
This next section is asking information about the person submitting this nomination form.
Name of nominating individual *
Your answer
Relationship to nominee
Your phone number *
Your answer
Please describe how the nominee meets the nomination requirements (which are listed here: https://thecentersd.org/about/wall-of-honor/lgbt-veteran-wall/veterans-candidate-criteria/). 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.
Your answer
Please name the two additional San Diego residents who will serve as co-sponsors of this application. *
Your answer
Nomination check-list
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 dvance@thecentersd.org or post mail to:
The Center
c/o David Vance
PO Box 3357
San Diego, CA 92163
Please check-off items you have completed/submitted.
If you are not submitting any piece of the required documentation from the nomination check-list, please note the reason below.
Your answer
A copy of your responses will be emailed to the address you provided.
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