WALL OF HONOR- Honoree information form


*HONOREE INFORMATION*

There form below is used to submit the information about the veteran you wish to have honored on the Wall of Honor.

Name of Service Member:

Service Date:

Service Location:

Campaigns (Wars):

Awards/Medals Received:

Photograph Available:

Yes No If yes please mail picture to:

The Portuguese Cultural Center c/o Wall of Honor
65 Sandpit Road
Danbury, CT USA 06810

Any other information pertaining to the individual's service that could tell the story of this great hero:

YOUR INFORMATION

Name:

Phone:

E-Mail: