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Recognizing our Vietnam Veterans: The Moving Wall Comes to the 1st District

If you are a Vietnam Era veteran living in the 1st District, someone with a VSO who works with these veterans, or the family member of a living or deceased Vietnam Era veteran, please provide some basic information about their service below so that they can be appropriatly honored during the Moving Wall's visit to the 1st District. When you have filled in the form, just click submit at the bottom and it will be sent to my office. Veterans (or their famlies) will be recognized throughout the Moving Wall's visit and will also recieve a special "Certificate of Congressional Recognition."

* indicates required field

Veteran's Information
*First Name
*Last Name
*Street Address
*City *State *Zip Code
*Phone Number
*Email Address (if none, type "none")

 

Veteran's Service Information
Approximately what dates did the Veteran serve during the Vietnam War Era?

Did the Veteran serve in the country of Vietnam?


Is the Veteran desceased?

 

Family Member Information (if necessary)
First Name
Last Name
Street Address
City *State *Zip Code
Phone Number
Email Address