Vietnam Cross of Gallantry
Replacement Recognition Application Form -- Australia

INSTRUCTIONS:

    1. Complete this form in full.
    2. Print and mail this completed form, along with a copy of your Certificate of Service or other pre-arranged military document(s) to the address below.

    Do Not Hilite, Underline, Circle, Colorize
    Or Mark In Any Way The Certificate of Service
    Or Other Military Document Photocopy
    You Will Mail.

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

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

    Service Branch:

    VCOG Awarded:
    [*] If Unit Award, provide Name of Unit:

    Rank Title (Please Do Not Abbreviate):

    Street Address:


    City:
    State:
    ZipCode:
    Phone:

    Full and complete contact email address:

    Recipient's Service Number:

    Is one of the following devices associated to the Vietnam Cross of Gallantry noted on your Certificate of Service or DD-215?:

    Palm Leaf | Silver Star | Bronze Star | Gold Star

    Date Arrived Vietnam:
    Date Departed Vietnam:

    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:

    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:

    Processing/Delivery:

  • U.S. delivery - Bond Enclosure $19.00US Navy Regal Black
  • U.S. delivery - Acrylic Frame, Acrylic face $19.00US Brown Black
  • U.S. delivery - Gold Color Frame, $24.00US Gold
  • U.S. delivery - Packaged to be framed by me $19.00US Unframed

    • Shipping cost to Australia is: $27.45US

    Would you like to receive the Official, full size Gallantry Cross replacement medal or replacement ribbon?

  • No, I already have the hardware

  • Yes, please include the official medal and add an additional $17.50 to my total

  • Yes, please include the official ribbon and add an additional $5.00 to my total

  • Yes, please include both the official medal and ribbon and add an additional $22.50 to my total

    • Would you like to receive the miniature Gallantry Cross replacement medal?

  • Yes, please include the miniature medal and add an additional $15.00 to my total

  • No, I already have the miniature

    • You will shortly receive a confirmation email/receipt acknowledging your application arrived, or should we have a question or require more information. Please ensure that you have entered a correct email address.

    To email this form click the button below. To mail this form address your envelope to:

    Records Chief (REC-AMW)
    The American War Library
    Building Two, 16907 Brighton Avenue
    Gardena CA 90247-5420