16 - TVCC –
WEEK OF NOVEMBER 16 - NOVEMBER 22, 2017
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SAMPLE INSCRIPTIONS
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HONORING
the Men, Women, and War Animals
who have served - or are serving -
HONORABLY in the
Armed Forces of the United States of America
Th is page sponsored by the Veterans Memorial Park Commission representing Florence V.F.W Post 3232, American Legion Post 59, Disabled
American Vets Chapter 23, Florence Band of Brothers. For more information contact : Dennis Marsh at 541-999-5462
REQUIRED INFORMATION - PLEASE PRINT CLEARLY
Sender’s Name _______________________________________
Mail Address: St./P.O. Box: _____________________________
Town/City: __________________________________________
State: ___________________________ Zip:________________
Contact: Phone/email address: __________________________
____________________________________________________
Cost is a donation of just $75 per paver brick. Only twenty (20) characters/spaces
on each line. Th ree (3) lines only. Only the FIRST 253 applications will be accepted.
All others received aft er this number has been reached will be returned to the sender.
Applications must be sent through the U.S. Postal Service only.
All applications are reviewed or corrected, and fi nalized for content by the VMPC.
Acknowledgement of receipt of an application will be made by the VMPC.
One application form per individual paver brick. Must include proof of military service,
i.e. copy of DD Form 214, or any Military orders indicating service (will be returned) with
the application. Veteran must have served HONORABLY or be serving in any branch of the
United States Armed Forces - including Reserves, or National Guard - overseas or CONUS.
Th e VMPC is a 501C(3) organization.
Enclose this application form with your donation by check or money order only (do NOT send cash),
and made out to: “VMPC” or “Veterans Memorial Park Commission”.
Application:
Line1: _______________________________________________________________________________
Line 2: _______________________________________________________________________________
Line 3: _______________________________________________________________________________
Mail to: VMPC, P.O. Box 1093, Florence, OR 97439