Veterans Granite Marker
Veterans Park, Brunswick, MD

RANK & NAME: _____________________________________________________________________________
(Rank is Optional)

Battalion/Company_____________________________________________________________________________

BRANCH OF SERVICE / YEARS OR WAR _____________________________________________________________________________

YOU MAY USE UP TO 55 CHARACTERS, LETTERS, OR NUMBERS ABOVE.
NO SYMBOLS MAY BE INCLUDED
THE BRUNSWICK VETERANS MONUMENT COMMITTEE RETAINS THE
RIGHT TO REJECT ANY WORDING THE COMMITTEE DEEMS
INAPPROPRIATE. THE COMMITTEE RESERVES THE RIGHT TO DENY
INSTALLATION OF ANY MARKER IT DEEMS INAPPROPRIATE.

SIGNED ____________________________________________________DATE__________________

PLEASE PRINT YOUR NAME:________________________________________________________

Your Details:                                                                                     Make your check Payable to
Name:_______________________________                                   
Address:  ____________________________                                     Brunswick Veteran
City: _______________________________                                   Monument Committee
State: _________ZIP__________________
Home Phone:_________________________Email:______________________________

 Please send this completed form with your check to:
 Brunswick Veterans Monument Committee
VFW Post #10421, 317 Brunswick Street
 Brunswick, MD 21716