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The United States of America
Vietnam War Commemoration
for Virginia Beach Vietnam Veterans
This template will help you provide the 
Event Coordinator with the necessary 
information to plan an appropriate
Commemoration Activity

This template should only be used if you are unable to 
use the web form available on the home page.

Please tell us your interest in attending a 
Virginia Beach Commemoration Event in the Fall of 2017

  *  Please provide the following information in your email
 "Event Coordinator" <>
 Commemoration Interest
 Your Last Name
 Your First Name and Initial

Did you serve on active duty in the U. S. Armed Forces  at any time 
during the period of November 1, 1955 to May 15, 1975, regardless 
of location? * Yes   No   Unsure   Prefer not to say
   If Yes, you are a Vietnam War Veteran
Service: *
 US Army
 US Air Force
 US Coast Guard
 US Marines
 US Navy
Last Rank:
 Your last rank
Would you
attend? *
 Depends on Date
 Probably Not
 Not Interested
Number of 
 How many?
Certificates of Honor are available for the following: *
 Former, Living American Military POW 
 or Surviving Spouse 
 Family Member of Unaccounted For 
 Family Member of In Memory Of 
 Deceased Vietnam Veteran's Surviving Spouse 
 None of the above