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           Brunswick Veteran Monument Committee
Name:_______________________________  
                                 
Address:  ____________________________ 
               
City: _______________________________   
                  
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

Contribution is tax deductible with a receipt when itemizing deductions

Print page-fill in information  and mail with your check as indicated.