Please complete this online form for yourself or a military Veteran you want recognized during the City of Victorville's Veterans Day Ceremony the morning of Nov. 12.  Information you provide will be used to honor your Veteran in the event program.  We are requesting Veteran photos to help us personalize the ceremony.  Instructions for submitting photos will be provided on Page 4.  This form must be submitted no later than:  Oct. 18.  While we will pay tribute to all Veterans during our celebration, the Salute to Victorville Veterans will give individual recognition to military Veterans who have lived in Victorville at some point in their lives.

1

INFORMATION ABOUT THE VETERAN

 *

Name of the Veteran to be recognized

2

Highest Rank Earned/Current Rank

 *

Highest Rank Earned/Current Rank

3

Branch of Service (Please select all that apply.)

Branch of Service (Please select all that apply.)

Air Force

Army

Coast Guard

Marines

Navy

4

Military Occupational Specialty or Code, if known (ie. Infantry, Combat Medic, Pilot, Mechanic, etc.)

Military Occupational Specialty or Code, if known (ie. Infantry, Combat Medic, Pilot, Mechanic, etc.)

5

Service

Service

Active Duty

Reserve

Active Guard

6

Date entered service

 *

Date entered service

7

Date ended service (If Veteran is still serving, answer "presently serving.")

 *

Date ended service (If Veteran is still serving, answer "presently serving.")

8

Did the Veteran retire from military service

 *

Did the Veteran retire from military service

No

Yes

Page 1 / 5