Your full name: (As you want it to appear on your Certificate)
Your complete street address: (Where you wnat you certificate mailed)
Your telephone number:
Your e-mail address:
Camp Name: (if you are a member of the SCV)
Information on your Confederate Ancestor(as you want it to appear on the certificate.)
Rank and Name of the soldier:
Military Unit and State, if known: (How you want it to appear on the certificate.)
Soldier's relationship to you:
Army Service Area in which your Ancestor served: Army of Northern Virginia Army of Tennessee Army of Trans-Mississippi
How did you hear about the CSA Army Service Medal? (select one) Saw it on your Web Site Confederate Veteran Magazine United Daughters of Confederacy Magazine Internet search Advertisement on SCV Texas Division Website Saw it announced on Facebook Anouncement at a Camp meeting Email from a friend Email or Letter from Joe Reynolds
If you would like to purchase additional bars to show different army areas in which your ancestor served, please list them in the comments section below.
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