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Registration for the Silver Valley Veterans Memorial Wall of Honor is free.  Simply fill out the form below and hit "Submit".  A confirmation e-mail will be sent to you once we receive your information.  Also, check out the limited opportunity for a personalized tile.  If you have any questions hit "Contact Us" above and select a representative to contact you. 

 

First Name: Middle Initial Last Name:

Branch of Service Rank:

Years of Service: To

Tour of Duty (WWII, Korea, etc.)

Dates lived within the Silver Valley to

Address while in the Silver Valley:

 

Contact Persons First Name: Last Name:

E-Mail Address: Phone Number:

Street Address: Apt. #

City: State: Zip Code: