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2. 
4. Full Name as Appears on Banner*
5. Branch of Service*
6. Military Rank*
8. Affiliation w/ Village of Richton Park*
9. Years of Service*
11. Proof of Residency

    (License, ID, Utility Bill, Certified Mail, etc.)

12. Photo of Veteran

    Must be in Military Uniform, High Resolution (200-300 dpi)

14. Verification of Active Duty Status

    (Military Orders, Military Identification, etc.)

15. Verification of Military Service

    DD214 or Honorable Discharge Certificate

19. Sponsor Name*
20. Address*
22. Email Address*
23. Phone
24. Relationship to Honoree*
28. Photo Release*

    1. Yes

    I hereby grant the Village of Richton Park permission to use the included photo in Richton Park's "Veterans of Valor" Banner Program with the understanding that this photo or likeness may be used for the Village’s promotional use. I assume all responsibility for providing accurate, true, and correct information regarding the Veteran being honored on the banner.

    The The Village of Richton Park is not responsible for lost or damaged banners due to natural acts. Banners will be retired and provided to sponsors as is.

32. Method of Payment*
    -- Select One --Check or Money OrderOnline
33. Electronic Signature Authorized*

    1. Yes

    I have read and fully understand and agree to the above stated conditions of participation in this event.

35. PAYMENT: CHECK or MONEY ORDER | $150

    If paying by check, please disregard payment screen upon submission.

    Please Submit Check or money order for $150 payable to Village of Richton Park (Please add “Veterans Of Valor Banner Program” in the Memo Line)

    If mailing payment, send to:

    • Village Of Richton Park
    • 4455 Sauk Trail Richton Park, IL 60471
36. PAYMENT: ONLINE | $150

    If paying online, please submit below. Upon Submission, you will be directed to our online payment server to complete your purchase. 

    1. At "Select a Payment Type" please scroll down through the list and choose "Miscellaneous Payment" at the bottom. 
    2. At "Description of Payment" please enter "Veterans Banner Program"
    3. Continue to Payment
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit Submit and Print

* indicates a required field