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:
Information on your Confederate Ancestor who was wounded or killed (as you want it to appear on the certificate.)
Rank and Name of soldier who was wounded or killed:
Military Unit and State, if known: (How you want it to appear on the certificate.)
Soldier's relationship to you:
Battle or Skirmish where soldier was Wounder or Killed (if known):
How did you hear about this medal? (select one) Saw it on your Web Site Confederate Veteran Magazine Internet search Advertisement on SCV Texas Division Website Saw it announced on Facebook Anouncement at a Camp meeting Email from a friend
How many medals do you wish to purchase?:
Comments:
