By signing (typing your legal name) in the space below, you are certifying:
I release this information to the Office of Congressman Mike Coffman for the use in the Vietnam Veteran 50th Anniversary Ceremony. I authorize the Office of Congressman Mike Coffman to release my name and photo in all promotional materials (website, e-newsletter, press release, ect.)
I am a legal resident of the State of Colorado.
If I have not submitted ALL required documents by the requested deadline, I will not be honored at the ceremony.
When you press the submit button below, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.