Honor and Remember, Inc.
Personalized Flag Request
We are dedicated to facilitating the presentation of personalized Honor and RememberÒ Flags for each family of a lost service member. With thousands of families to reach, including WWII, Korea and Vietnam, gifting is only possible with donated resources or specific sponsorships through individuals or organizations.
We would like to properly prepare this personalized tribute and in order to insure accuracy please provide us the specific information requested below.
Please print or type: Name of Requestor: ______Date: ______
Flag for yourself or someone else? ______Will this be a surprise? ______
Person to receive Flag: ______
Relationship to Service Member: ______
Email address: ______
Street Address: ______
City, State & Zip code: ______
Home phone: ______Work phone: ______Cell phone: ______
Fallen Hero information: Example: Cpl George A. Lutz II ~ 29 Dec 2005 ~ Iraq
Abbreviated Rank and Full Name______
Branch of Service: ______
Date of Birth: ______Date of Death: ______Place of Death: ______
Nickname or called Name: ______Cause of Death and Short story or additional information: Use separate sheet if needed.
______
______
We want to be sure that each loved one is respectfully recognized and honored individually by name and that each family’s sacrifice not be forgotten. Because of the importance of this campaign in educating the country in the daily remembrance of each precious life, these presentations are suggested to be made formally in public.
We can arrange for a short ceremony in your area, however, it would be best if you could recommend a time and place meaningful for the presentation. In order to arrange this please send us any organizations that you are associated with or your possible venue recommendations:
Veteran’s organization: ______
Contact Name: ______Contact #: ______
Community or Church Group: ______
Contact Name: ______Contact #: ______
Please return form either by: Email, , Fax 757-204-4726,
or mail - Honor and Remember, PO Box 16834, Chesapeake, VA 23328. Thank you.
Office Use Only : Date Received ______Date Scheduled ______Sponsor ______