Gloversville Hometown Heroes Registration
Gloversville Hometown Heroes Registration Form
Veteran Name
*
Rank
First Name
Middle Name
Last Name
Suffix
Branch of Service
*
Army
Navy
Marines
Air Force
Coast Guard
National Guard
Reserves
Service Start Year
*
Service End Year
*
Hero Photo
*
Browse Files
Drag and drop files here
Choose a file
Only PNG, JPEG, or JPG files are able to be submitted.
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of
Medals Awarded
For a directory of military medals, please visit downtowngloversville.org/HometownHeroes
DD Form 214 Upload
Browse Files
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All DD Form 214 submissions will be destroyed immediately following proper review.
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of
Sponsor Email
*
example@example.com
Sponsor Phone Number
Please enter a valid phone number.
Sponsor Display
*
Displayed as written
Preferred Location
Specific banner location requests will be determined on a first-come, first-served basis.
Additional Comments
Is there any special you would like to share about your hero?
Purchase Summary
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Hometown Hero Banner & Installation
18 x 36 personalized hometown hero banner and installation 5/28/21 - 5/27/22
$
100
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
Billing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
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