Sample Application

Anyone residing in WNY who has a friend or family member currently deployed in combat is encouraged to submit a photograph to be included on the tribute Wall of “Honor, Recognition and Prayer.”  The photograph should be a clear copy or original print in a Portrait Style (Vertical) and 8 x 10 or 8.5 x 11 in size.  PHOTOGRAPH WILL BE RETURNED TO YOU.

PLEASE COMPLETE ALL INFORMATION REQUESTED BELOW

SERVICE MEMBER INFORMATION


NAME:     __________________________________________________________
BRANCH OF SERVICE:   _____________________________________________
RANK: ____________________________________________________________
HOMETOWN: ______________________________________________________
DATE DEPLOYED:___________________________________________________
WHERE DEPLOYED:_________________________________________________
EXPECTED RETURN DATE: __________________________________________

SPONSOR INFORMATION


NAME: ____________________________________________________________
RELATION TO SERVICE MEMBER: ___________________________________
MAILING ADDRESS: ________________________________________________
                               ________________________________________________
TELEPHONE #: ____________________________________________________
EMAIL ADDRESS: __________________________________________________

 

PLEASE RETURN APPLICATION AND PHOTOGRAPH TO:

MILITARY WALL OF HONOR
WESLEYAN CHURCH OF HAMBURG
S4999 MCKINLEY PARKWAY
HAMBURG NY 14075