Nominee Name: Age:

Complete Address:

Phone Number:

E-Mail Address:

Resident of Forsyth County?: YES NO  Number of Years in Forsyth County:

Branch of Service: Years: Retired Active   Current Rank:

Served in WWII Korea Vietnam Afghanistan Iraq   Other:

Military Awards, Citiations, Commendations, Decorations:

Post-Service Occupation:   Years:

Why are you nominating this person?:

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Address:  Phone

E-Mail Address:  Date