Telephone and Fax: 1-310-532-0634

Govt of Korea, Belgium or France
Korean War (U.N./Allied) Service Medal
Replacement Recognition Application Form

INSTRUCTIONS:

    1. Complete this form in full.
    2. Print and mail this completed form, along with a copy of your or the veteran's DD-214, WD AGO 53-55, NAVPERS 553, NGB 22, or other pre-arranged military document(s) to the address at the bottom of this secure form.

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

    The Replacement Recognition I am applying for is the:

    • Bravery Gold Medal of Greece
    • 60th Anniversary, United Nations
    • 60th Anniversary, United States
    • Republic of Korea
    • Republic of France
    • Medal of Volunteers, Belgium
    • Kingdom of Belgium (*)
      (*) (NOTE: the Belgium Replacement Recognition was originally restricted to all members of the U.S. Navy, Marine Corps, Air Force and Coast Guard and U.S. Army issue was restricted to "RA" Service Numbers and Officer personnel only; "US" Service Numbers were ineligible]. The Belgium award has since been authorized to all US servicepersonnel.)

    Recipient's LAST Name:
    FIRST Name:
    MIDDLE name:
    Title (Must appear on DD-214):Jr Sr II III IV

    Service Branch:

    Rank Title (Please Do Not Abbreviate):

    Street Address:

    City:
    State:
    ZipCode:
    Phone:

    Full and complete contact email address:

    Recipient's Service/Serial Number:

    Month and Year Arrived Korea:
    Month and Year Departed Korea:

    If you are sending a check or Money Order please indicate:

    • I will mail a check along with my application and documentation

    • I will mail a money order along with my application and documentation

      • (Make payable to "Records Chief")

    Charge or Debit Card applicants, please complete the following:

    Please choose between ASAP or Monthly shipping...

  • I want the items on this Application Form (and other Forms I am submitting today) to be shipped As Soon As Possible.
  • I want the items on this Application Form (and other Forms I am submitting today) to be shipped in monthly groups of...

      Ship 1 of my Application Forms per month
      Ship 2 of my Application Forms per month
      Ship 3 of my Application Forms per month
      Ship 4 of my Application Forms per month

    Bill my charge/debit card and send me an email receipt between the 1st and 5th day of each month for each shipment. Please note that I am using a credit/debit card that will not expire before all of my monthly shipments have been sent to me.

    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

    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...
  • .PDF Emailed - $9.50 Black & White (No Color)
  • U.S. delivery - $21.20 Full Color Document Only
  • U.S. delivery - Full Color Document in Bond Enclosure
  • 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.)
  • Would you like the full-color Wallet Size Certificate along with one of the above full-size color Certificates ($3.50) Yes No
    I want Certificates in pdf format on a CD rom...

  • I want ALL of my Certificates in full color; $10.00 per Certificate
  • I want SOME of my Certificates (minimum 20) in full color; $10.00 per Certificate; I will be emailing a list of the 20 or more Certificates I want
  • I want ALL of my Certificates in Black&White; $8.00 per Certificate
  • I want SOME of my Certificates (minimum 20) in Black&White; $8.00 per Certificate; I will be emailing a list of the 20 or more Certificates I want
  • No CDrom

    Would you like to receive the Official, full size Republic of Korea replacement medal and/or ribbon?

  • Yes, please include the official medal and add an additional $21.50 to my total.

  • Yes, please include the official ribbon and add an additional $4.00 to my total.

  • Yes, please include the official medal and the ribbon, and add an additional $25.50 to my total.

  • No, I already have the hardware.

    • 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

    • Would you like to track your package through the United States Post Office after it has been shipped (for seventy [.70] cents extra)?

  • Yes, add USPS's 45 cent tracking fee to my total

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

    • SENDING INSTRUCTIONS

    Please do the following, in order:

    1. Print this Form now.

    2. If using your charge/debit card, enter the card number and the card's expiration date. Sign the form.

    3. After completing the form mail it, along with a photocopy of your DD-214 to the address below (for faster processing and delivery, charge/debit applicants may FAX this application and their DD-214). (PRIOR APPLICANTS: If you have previously mailed your DD-214 to The War Library you do not need to mail it again. Simply click the SEND button below.)

    4. Click the SEND button below to notify The War Library that your DD-214 will be arriving by fax or within a few days by mail.

Click Here if you are a Prior Applicant
New Applicants Click Here

MAILING ADDRESS
Records Chief (REC-AMW)
The American War Library
16907 Brighton Avenue
Gardena CA 90247-5420
Phone/Fax: 1 310 532 0634