Application for Town of Cairo Hometown Heroes Banner Program

Deadline for Banner applications is March 31, 2015 

Name of Hometown Hero:___ ________________________________________ 

Branch of Service:
□ Army    □  Navy    □  Air Force    □  Marine    □ Coast Guard 

Conflict (Check all that apply):
□ Revolutionary War □ War of 1812 □ Indian Wars □ Mexican-American War   

□ Civil War   □ Spanish-American War    □ World War 1    □ World War 2

□ Korean   □ Vietnam War  □  Persian Gulf  □  Iraq War  □  Afghan War  

□ Other (please specify) _______________________________________________ 

Was the Hometown Hero killed in active service?   □ yes  □ no 

If so, when and where did he/she die? _________________________________ 

Was the Hometown Hero a POW? □ yes  □ no 

If so, when and where? _____________________________________________

Was the Hometown Hero MIA? □  yes  □  no 

If so, when and where?  _____________________________________________

What was the Rank of the Soldier and the Regiment and Company in which he/she served?

_______________________________________________________________

Please state when the Hometown Hero lived in the Town of Cairo and for what
length of time:

_______________________________________________________________

______________________________________________________________

Submitter info:
Name: _________________________________________________________

Address: _______________________________________________________

Phone: _________________________________________________________

Email: _________________________________________________________

Relationship to Hometown Hero: ___________________________________

□ Check here to indicate that a portrait photo, preferably in uniform, of the proposed Hometown Hero is enclosed (minimum size 4”x6”)

Please indicate whether you need the original photograph returned to you.
□ yes  □  no

There are four styles to choose from. Please indicate which style you have chosen. Style 4 is reserved for Veterans who were killed in active service:   
                  □  Style 1        □  Style 2        □  Style 3         □  Style 4

Please indicate what you would like placed in the Sponsor line. In the examples attached you see that The Houghtaling Family is in the sponsor line. There are
25 spaces available. Please print in Block letters.

________________________________________________________________

I hereby grant Cairo Historical Society permission to use the veteran’s photo in the Town of Cairo Hometown Heroes Banner Program and related promotional literature without payment or other consideration.

Signature of Applicant:   ____________________________________________

Date:_____________________________________________________________

 

Additional Information
(Optional) 

The Cairo Historical Society is collecting information on our veterans for our historical files. If you are interested in adding your Hometown Hero to this database please complete the following questionnaire (you do not have to purchase a banner to participate): 

Name of Veteran: _________________________________________________ 

Date and Location of Birth: _________________________________________

Name of Parents: __________________________________________________

Name of Spouse: __________________________________________________

Date and Location of Marriage: ______________________________________ 

Names of Children: ________________________________________________ 

_________________________________________________________________

_________________________________________________________________

What was/is the Veteran’s profession:_________________________________

_________________________________________________________________

Date and Location of Death (if Applicable): ____________________________

_________________________________________________________________

Location of Burial: _________________________________________________

Length of Service in the Military: _____________________________________

Branch of Service and Rank in the Military:_____________________________

Company/Regiment/Ship:___________________________________________

What medals, decorations, citations or awards did he/she receive? _________

_______________________________________________________________

In which military theater did he/she serve? _____________________________

Do you have any letters from the serviceman or woman while in active service?
□  yes  □  no

Would you be willing to donate the original or copies of the original letters to
the Cairo Historical Society?
□  yes  □  no

Do you have other military artifacts you would like to donate to the Cairo Historical Society?
□  yes  □  no

Please describe these items in your collection:

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

Other information or memories about the Veteran: _______________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

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