GOLD STAR INFORMATION FORM

Name of Sky Soldier:__________________________________________________________________________

Unit Served with:______________________________________________________________________________

Sky Soldier’s Place and Date of Birth:______________________________________________________________

Sky Soldier’s Hometown:________________________________________________________________________

Sky Soldier’s Date of Death:______________________________________________________________________

___________________________________________________________________________________________

Sky Soldier’s Panel number on The Vietnam Memorial Wall:______________________________________________

Sky Soldier’s Father’s Name/address/phone/e-mail:____________________________________________________

___________________________________________________________________________________________

Sky Soldier’s Mother’s Name/address/phone/e-mail:___________________________________________________

___________________________________________________________________________________________

____________________________________________________________________________________________

Other nearest living relative, i.e. sister, brother Name/address/phone/e-mail:___________________________________

____________________________________________________________________________________________

Do You have a Gold Star Membership Card from the Society Yes ___ No ____

Please provide proof of death, i.e. DD Form 1300 or DD Form 214 Yes ___ No ____

If not, would you like an application for replacement pin? Yes ___ No ____

Do you have a Gold Star Pin? Yes ___ No ____

Are you on the Society Mailing List? Yes ___ No ____

Have you ever attended a Reunion? Yes ____ No ____

Would you like more information about Reunions? Yes ____ No ____

Remember, The Herd Never Forgets! Yes ____ No ____

Please complete the attached form and mail to Gold Star Chairperson:

Gold Star; LTC Mary Sanders, 2181 The Villages, FL 32162