Vietnam War 50th Commemoration - Application Form
Congresswoman González-Colón would like to ensure all eligible Vietnam War-era veterans in Puerto Rico receive a Service Lapel Pin and the recognition they deserve. If you are interested in receiving a Service Lapel Pin, please complete the application below. If available, you may also submit your DD Form 214, Certificate of Release or Discharge from Active Duty (DD-214).
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Veteran's Full Name: *
Postal Address: *
Family Member Name and Relation (If the Vietnam Veteran is being awarded posthumously, please provide the full name and relation of the family member accepting the pin on his/her behalf): *
Birth Date of Veteran: *
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Phone Number: *
Home Address *
Branch of Military Service: *
Dates of Service: *
Location(s) of Service: *
Is there any other information you would like our office to know about you?
Would you like to sign up for Congresswoman González-Colón's newsletter? *
If yes, please provide your email address:
Applicant’s Signature *
By signing your name below, you are certifying: I release this information to the Office of Congresswoman González-Colón for the use in the Vietnam War 50th Commemoration. I authorize Congresswoman González-Colón to release my name and photo in all promotional materials (website, e-newsletter, press release, etc.)
Please complete and mail this completed form (along with any additional, optional materials such as a DD-214, headshot, and any other materials) to José Olmos at the address below, or by email: Jose.Olmos@mail.house.gov.
Mailing Address: Office of Congresswoman Jenniffer González Colón, Attention: José Olmos, P.O. Box 9023958, San Juan, PR 00902-3958 Telephone: 787-723-6333
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