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Military Recognition Banner Program

2. 

4. Military Service Person

6. First Name*

7. Last Name*

9. Enlistment Date (MM/DD/YYYY)*

10. Anticipated Date of Discharge (MM/DD/YYYY)*

12. Branch of Service*
    -- Select One --U.S. Air ForceU.S. ArmyU.S. Coast GuardU.S. MarinesU.S. National GuardU.S. NavyU.S. Space Force

16. Sponsor Contact Information

18. First Name*

19. Last Name*

21. Address1*

23. Address2

25. City*

26. State*

27. Zip

29. Phone Number*

30. Email Adress*

32. Relationship to Service Person*

36. Payment & Photo

38. Payment must be made in the Recreation Office at City Hall, 14000 City Center Drive, Chino Hills, CA 91709. The City accepts cash, check or credit card (please note there is a 2.5% fee for credit card transactions).

40. A 5x7 or larger colored photograph of the service person in uniform must be provided. please do one of the following:

42. Digital Photo - upload a .jpeg or .pdf file below

44. Printed Photo - bring a 5x7 or larger photo when you come to the office for payment. Staff will scan the image and return it to you.

46. File Upload (.jpeg or PDF)

Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field