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Recreation Programs and Facilities Survey 2017
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Military Recognition Banner Program
This form has been modified since it was saved. Please review all fields before submitting.
Military Service Person
First Name
*
Last Name
*
Enlistment Date (MM/DD/YYYY)
*
Anticipated Date of Discharge (MM/DD/YYYY)
*
Branch of Service
*
-- Select One --
U.S. Air Force
U.S. Army
U.S. Coast Guard
U.S. Marines
U.S. National Guard
U.S. Navy
U.S. Space Force
Sponsor Contact Information
First Name
*
Last Name
*
Address1
*
Address2
City
*
State
*
Zip
Phone Number
*
Email Adress
*
Relationship to Service Person
*
Payment & Photo
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).
A 5x7 or larger colored photograph of the service person in uniform must be provided. please do one of the following:
Digital Photo - upload a .jpeg or .pdf file below
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.
File Upload (.jpeg or PDF)
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