Application for Town of Cairo Hometown
Heroes Banner Program
Deadline for Banner
Applications is
March 1, 2018
Name of Hometown Hero:___ ________________________________________
Branch of Service:
□ Army □ Navy □ Air Force □ Marine □ Coast Guard
Conflict (Check all that
apply):
□ Revolutionary War □ War of 1812 □ Indian Wars □ Mexican-American War
□ Civil War □ Spanish-American War □ World War 1 □ World War 2
□ Korean □ Vietnam War □ Persian Gulf □ Iraq War □ Afghan War
□ Other (please specify) _______________________________________________
Was the Hometown Hero killed in active service? □ yes □ no
If so, when and where did he/she die? _________________________________
Was the Hometown Hero a POW? □ yes □ no
If so, when and where? _____________________________________________
Was the Hometown Hero MIA? □ yes □ no
If so, when and where? _____________________________________________
What was the Rank of the Soldier and the Regiment and Company in which he/she served?
_______________________________________________________________
Please state when the Hometown Hero lived in the Town of Cairo and for what
length of time:
_______________________________________________________________
Which hamlet would you like to see the banner placed? (Every effort will be made
to
accommodate your request
□ Cairo Village □ Acra □ Purling □ Round Top □ South Cairo
Submitter info:
Name: _________________________________________________________
Address: _______________________________________________________
Phone: _________________________________________________________
Email: _________________________________________________________
Relationship to Hometown Hero: ___________________________________
□ Check here to indicate that a portrait photo, preferably in uniform, of the proposed Hometown Hero is enclosed (minimum size 4”x6”)
Please indicate whether you need the original photograph returned to you.
□ yes □ no
There are four styles to choose from. Please indicate which style you have
chosen. Style 4 is reserved for Veterans who were killed in active service:
□ Style 1 □ Style 2 □ Style 3 □
Style 4
Please indicate what you would like placed in the Sponsor line. In the examples attached you see that The Houghtaling Family is in the sponsor line.
There are 25 spaces available. Please print in Block letters.
________________________________________________________________
I hereby grant Cairo Historical Society permission to use the veteran’s photo in the Town of Cairo Hometown Heroes Banner Program and related promotional literature without payment or other consideration.
Signature of Applicant: ____________________________________________
Date:_____________________________________________________________
Additional Information
The Cairo Historical Society is collecting information on our veterans for our historical files. If you are interested in adding your Hometown Hero to this database please complete the following questionnaire (you do not have to purchase a banner to participate):
Name of Veteran: _________________________________________________
Date and Location of Birth: _________________________________________
Name of Parents: __________________________________________________
Name of Spouse: __________________________________________________
Date and Location of Marriage: ______________________________________
Names of Children: ________________________________________________
_________________________________________________________________
_________________________________________________________________
What was/is the Veteran’s profession:_________________________________
_________________________________________________________________
Date and Location of Death (if Applicable): ____________________________
_________________________________________________________________
Location of Burial: _________________________________________________
Length of Service in the Military: _____________________________________
Branch of Service and Rank in the Military:_____________________________
Company/Regiment/Ship:___________________________________________
What medals, decorations, citations or awards did he/she receive? _________
_______________________________________________________________
In which military theater did he/she serve? _____________________________
Do you have any letters from the serviceman or woman while in active service?
□ yes □ no
Would you be willing to donate the original or copies of the original letters to
the Cairo Historical Society?
□ yes □ no
Do you have other military artifacts you would like to donate to the Cairo
Historical Society?
□ yes □ no
Please describe these items in your collection:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Other information or memories about the Veteran: _______________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________