Hometown Hero Application

Bethel Township Hometown Hero Banner Program
Name of person in Photo

First NameLast Name
Era of service ( WWI, WWII, Vietnam, etc **Era of Service - Official DOD Dates** Global War on Terrorism Desert Storm Persian Gulf Vietnam Korean ConflictSeptember 11, 2001 - Present January 17, 1991 - Present August 2, 1990 - August 31, , 1991 February 28, 1961 - May 7, 1975 June 27, 1950 - January 31, 1955 April 6, 1917 - November 11, 1918 December 7, 1941 - December 31 1946)
Branch
Proof of Service (if available)

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Hometown
Alive
Deceased
KIA
POW/MIA
Name of person submitting photo
Relationship to Hero
Phone Number
Please enter a valid phone number.
Address
Email
example@example.com
I hereby grant the Siloam United Methodist Church and Bethel Township permission to use the attached photo (which includes a likeness of me, my relative, or person being sponsored) in the Hometown Hero Banner Program without payment or other considerations.
Printed Name
Signature

Clear
Date

MonthDayYear
Date
File Upload

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Questions concerning qualification or application, contact Christina Saunders @ csaunders@comcast.net or 610-633-3308
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