Veterans Paver Form

Posted 05/05/2010

Each paver may have up to three lines of text, no more than 18 characters – including spaces per line. Please adjust the name to fit the allotted spaces. Abbreviations for service are provided below. Placement of the paver in the Memorial will be determined in the order in which purchase is received. (Abbreviations: USA, USMC, USN, USAF, USCG, USMM, AZANGB, AZAFNGB (State abbreviation, A or AF, National Guard Bureau). This is a non-refundable order.

Please complete the following required information for the paver layout:

First Line (Name of Veteran): *

20 characters max.

Second Line (Rank / Rate):

If you prefer not to include Rank/Rate or do not know the Veteran's Rank/Rate, you may leave this line blank.
20 characters max.

Third Line (Service Branch and Date of Service):

If you prefer not to include or do not know the Veterans’ years of service, you may leave this portion of the line blank.
MIA: Service, year entered – MIA (USA 1965-MIA)
KIA: Service, KIA, date KIA (USA KIA 11-12-65).
POW: Service, year served POW (USAF 1965-1985 POW)
Active Military: For Active Military on line three, please use the Service Branch abbreviation, followed by the year entered the service, followed by a dash.
Example:
Line One: Mary Jo Pennel
Line Two: Captain
Line Three: USMC 2000-

Required Information To Process Order:

Your Name: *

Street Address: *

City: *

State: *

Zip Code: *

Phone Number: *

Only used to contact you in case there are questions about your order.

Email: *

To be used only in case of order question or Memorial event notification.

*IMPORTANT - Before you submit this form, please go back and verify that all information is correct. Once you click "Pay Now" you cannot go back and change this information.

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