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Warrant Please select... W1 W2 W3 W4 W5
Officer Please select... O1 O2 O3 O4 O5 O6 O7 O8 O9 O10

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Overseas Mission: Please select... Afghanistan Dominican Republic El Salvador Grenada Iraq (post 2003) Korea Kosovo Panama Persian Gulf (1990-1995) Somalia Southeast Asia Vietnam WW2

Other area:

Date of Arrival in Hostile Theater:
Date Departed Hostile Theater:

If you are sending a check please indicate:

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



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Charge or Debit Card applicants, please complete the following:

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:



• I would like the following Display Recognition...
  

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• .PDF Emailed - $7.50 Full Color
• U.S. delivery - $21.15 Full Color Document Only
• U.S. delivery - $27.35 Full Color Document in Bond Enclosure
• I want ALL or SOME of my Certificates (minimum 20) in pdf format that I can print continuously, shipped to me on a CD rom that I can make copies of. (Library Note: See below for details)
• I do not want the Display Recognition. I am requesting the hardware items listed below (medal, badge, ribbon or patch) if they are available for this award. (Shipping cost applies to non-certificate requests.)

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• Would you like the full-color Wallet Size Certificate along with one of the above full-size color Certificates ($3.50) Yes No

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  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

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Would you like a published copy of My Military Medal Last Will And Testament?

• Yes, please include a Medal Will for a male heir of my medals and add $4.00 to my total


• Yes, please include a Medal Will for a female heir of my medals and add $4.00 to my total


• No, I will obtain the free jpg copy

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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

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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. After clicking the button below to send this Form you will soon receive a confirmation email containing final instructions on which items, if any, are needed to fulfill your request. Your DD-214 can be mailed, faxed or emailed. (Non-personalized items such as hardware may be exchanged or returned within ten days of delivery. Name-Personalized items such as Certificates that are produced uniquely for a recipient may not be exchanged or returned.)