Flags Across America
DONATION TOWARDS VETERAN MEMORIAL
Fill out this form with the name of the soldier or veteran you want on the paving stone.
You may purchase any number of paving stone.
A paving stone donation is just $25.00.
You can put the name of your Grandfather, Grandmother, Father, Mother, Brother, Sister, Uncle, Aunt, Nephew, Niece, Cousin, or personal friend
who served in one of the Armed Forces.
I would like to purchase a paving stone engraved as follows:
1. VETERAN’S NAME: _____________________________________________
VETERAN’S RANK: _____________________________________________
VETERAN’S BRANCH OF SERVICE AND WAR:
_____________________________________________
2. VETERAN’S NAME: _____________________________________________
VETERAN’S RANK: _____________________________________________
VETERAN’S BRANCH OF SERVICE AND WAR:
_____________________________________________
3. VETERAN’S NAME: _____________________________________________
VETERAN’S RANK: _____________________________________________
VETERAN’S BRANCH
OF SERVICE AND WAR:
_____________________________________________
Signed:
Address:________________________________________________________________________
Phone:
___________________________________
Number of paving stones ordered: @$25.00 ea. Paid: Check Cash
Please make your checks out to:
Veteran’s Memorial. Put in memo
“Brick”.
Drop the form and generous donation
in a box (located at: Vets Club, Elks Club, or Great Book
Store).
or
mail to: Veteran’s Memorial, Attn:
J.A. Carlascio, 710 2nd St S.W., Jamestown, North Dakota,
58401
For Office Use Only: