Phone: 1-562-422-4100

Persian Gulf Campaign 20th Anniversary
Replacement Recognition Application Form

INSTRUCTIONS:

    1. Complete this form in full.
    2. Click the button at the bottom of this completed form to email it to The War Library, or you can Print and mail this form along with a copy of the DD-214, WD AGO 53-55, NAVPERS 553, NGB or other pre-arranged documents to the Library's mailing address below.

    Do Not Hilite, Underline, Circle, Colorize
    Or Mark In Any Way The DD-214
    Or Other Military Document Photocopy
    You Will Be Sending.


    I am applying for...

  • I am authorized the Southwest Asia Service Medal. I want the 10th Anniversary Display Recognition issued in my name
  • I want the 20th Anniversary Display Recognition issued in my name
  • I am a family member or friend of a Persian Gulf Campaign veteran. I want the 10th Anniversary Display Recognition issued in the Vet's name
  • I want the 20th Anniversary Display Recognition issued in the Vet's name
  • I did not serve in the Persian Gulf Campaign. I want the Un-Named 10th Anniversary Display Recognition as a Historical/Commemorative document to personally honor those who served
  • I want the Un-Named 20th Anniversary Display Recognition

  • LAST Name:
    FIRST Name (as it appears on the Report of Separation):

    MIDDLE name (as it appears on the Report of Separation):
    Title (Must appear on military documentation):Jr Sr II III IV

    Persian Gulf Campaign Veterans Only: Service Branch:

    Persian Gulf Campaign Veterans Only: Rank Title (Please Do Not Abbreviate):


    I have not moved. My current address info is on file from a previous application

    Address:
    City:
    State:
    ZipCode:
    Phone:


    Full and complete contact email address:

    Persian Gulf Campaign Veterans Only: Service Number:

    Persian Gulf Campaign Veterans Only: Date Arrived Southeast Asia Territory:
    Persian Gulf Campaign Veterans Only: Date Departed Southeast Asia Territory:


    PERSIAN GULF CAMPAIGN VETERANS ONLY: UNIT / VESSEL INFORMATION

    The name/number of your Company or Vessel:

    If your unit was part of a Battalion what is the name/number of your Battalion:

    If your unit was part of a Regiment what is the name/number of your Regiment:

    If your unit was part of a Brigade or Air Group what is the name/number of your Brigade or Group:

    If your unit was part of a Division or Air Wing what is the name/number of your Division or Wind:


    If you are sending a check or USPS money order please indicate:

    • I will mail a check along with my application and documentation. The Library will receive my envelope within 10 days from today.

    • I will mail a USPS money order along with my application and documentation. The Library will receive my envelope within 10 days from today.

    CHARGE or DEBIT CARD applicants:

    -- My current Card information is already on file from a previous Application

    If your Card information is not on file, please Complete the following...

    Your Name as it appears on your charge or check debit card:

    Payment Method
      Check Debit
      Visa
      MasterCard
      American Express
      Diners Club
      Carte Blanche

    Card number:
    Expiration Date
    Card Verification Number (CVV Code) (See below)
    American Express: 4 digits on front of card
    All other cards, 3 digits on back

    After printing this form for mailing, please sign here:

    International shipping cost (U.S. veteran living outside the United States, please add the shipping cost you were quoted...

    TOTAL ADMIN PROCESSING/DELIVERY:

  • .PDF Emailed - $7.50 Full Color
  • U.S. delivery - $22.35 Full Color Document in Bond Enclosure
  • U.S. delivery - $27.35 Full Color Document in Bond Enclosure
  • Would you like the full-color Wallet-Size Card Certificate along with one of the above full-size color Certificates
    Yes, Unlaminated ($3.50)
    Yes, Laminated ($6.00)
    No
    SKIP THIS SECTION IF YOU ARE NOT REQUESTING A CD-ROM...
    I want Certificates in pdf format on a CD rom...


  • I want of my Certificates (minimum 20) in full color; $7.50 per Certificate on CD-ROM. I will be emailing a list of the Certificates I want

  • No CDrom

    Would you like an archive (black&white) copy of the Certificate you are applying for to be mailed from the Records Chief directly to your Commanding Officer -or- to your Employer -or- to your School Administrator for inclusion into your permanent personnel file jacket?
    (Fee: $3.50)

  • No.
  • Yes, please mail an embossed, B&W copy of my Certificate to the following person and address:
  • Official's name
    Official's Title
    Official's Agency Name (name of unit, vessel, office, school, etc.)
    Address
    City, State, Zip


    Would you like to track your package through the United States Post Office after it has been shipped (for seventy-five [.75] cents extra)?

  • Yes, add 75 cents to my total

  • No, I don't want to track my package

  • Click Here if you are a Prior Applicant who's DD-214 is on file
    New Applicants Click Here

    Your Application Form is now complete. Print, Sign and Mail this completed form to the address below along with the required military-issued Report of Separation or other (pre-approved) document(s). You may (OPTIONAL) email this form for faster processing. However, you must still mail or email a copy of your military document(s).

    Records Chief (REC-AMW)
    The American War Library
    817 East Via Carmelitos
    Virginia Building 319
    Long Beach CA 90805-7549
    Phone: 1-562-422-4100
    Policy Statements On Display Recognitions and Hardwear

Print a copy for yourself before clicking the bar below..