Phone/Fax: 1-310-532-0634

    Marine Corps Professional
    Recognition Application Form

    INSTRUCTIONS:

1. Complete this form in full.
2. Print and mail or fax this completed form, along with a photocopy of the required document(s) described on the Instruction Page, or other pre-arranged document(s) to the address below.

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

Charge card or Debit card applicants: To expedite shipment of your Recognition you may email this form today. Your Recognition will be prepared and awaiting the arrival of your DD-214 or other, pre-arranged military document(s).

    Marine Corps Occupation:

    Other USMC Profession not listed above...

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

    Rank:

    Street Address:

    City:
    State:
    ZipCode:
    Phone:

    Your full and complete email address:

    Recipient's Service Number:

    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

    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 - $25.70 Full Color Document in Bond Enclosure
    • Would you like the full-color Wallet Size Certificate along with one of the above full-size color Certificates ($3.50) Yes No
    • 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 a CDrom of ALL your Certificates which you can make copies of, and print on paper (you must request a minimum of 20 Certificates)...

    • Yes ($10.00 per Color Certificate, minimum 20)
    • Yes, ($8.00 per B&W Certificate, minimum 20)
    • No CDrom

      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 using the internet through the United States Post Office after it has been shipped (for seventy [.70] cents extra)?

    • Yes, add 70 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. After clicking the grey-bar 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).

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