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2. 
3. SUMMIT HOMETOWN HEROES APPLICATION
5. I approve and authorize the use of my image or my family member's image and name on a Hometown Heroes banner to be displayed in Summit, New Jersey. I confirm that I, or my family member, meet eligibility requirements.
7. electronic signature*
9. First Name
10. Last Name
12. Address
14. Phone
15. Email
17. Exact name to appear on banner:*
    (Example= John D. Smith or Capt. John D. Smith)
19. Branch of Service:*
    (Army, Navy, Air Force, Marines, Coast Guard, Merchant Marine, Women Airforce Service Pilots)
21. Years of Service or War or Conflict:*
    (Example: 1940-1944 or World War II. A war or conflict should be listed only if the individual served in a combat zone. If the individual is currently on active duty, it is sufficient to list "active duty" on the form.)
23. Please check one*

    1. Lives (or lived) in Summit, New Jersey
    2. Works (or worked) for the City of Summit or Summit Board of Education
    3. Volunteers (or has volunteered) for Summit EMS, Police Auxiliary or Volunteer Fire Division
27. PLEASE SUBMIT ALONG WITH THE FORM:
29. 1) A high resolution photograph of the honored individual in military uniform.
31. 2) A copy of the individual's "DD Form 214" (certificate of Release of Discharge from Active Duty) or other appropriate documentation of individual's service.
33. Email the form to: summitnjheroes@gmail.com
    The Summit Free Public Library can assist applicants with making a submission by email.
35. OR
37. By USPS Mail:
    Summit Hometown Heroes P.O. Box 892 Summit, NJ 07902 *Please include a self- addressed, stamped envelope if you would like the photograph to be returned.
39. If you have any questions, please contact us by email at summitnjheroes@gmail.com.
41. THANK YOU FOR YOUR SERVICE!
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit Submit and Print

* indicates a required field