| Name | __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ (Last) (First) (M.I.) |
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| __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ (Branch of Service) (Dates of Service) |
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| Cost $100 per Veteran | _________________________ Verification of Signature |
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| Make checks payable to Veterans Memorial. Signature verifies the above information is correct. This information will be used on the memorial. Please note: space is limited to 18 characters (including blank spaces) per line. |
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Please mail to:
Vets Memorial
P.O. Box 2
Watertown, SD 57201