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7 - Application for OSR Award...

Application for the Order of Silver Rose Award

- Please Note: All the following information is final as written!!!
- Print Clearly, and feel free to use additional pages if needed.
- This application must be Totally Completed and mailed with all requested information for consideration included!

Name:___
(Print the first, middle name or initial and last as you want it written on the award and The Rank (I.E. Specialist E-4 etc.) as you want it on the award.)

Address:___

City, State and Zip Code:___

Email Address:___

Evening Phone number:___

Day number if available:___

Branch of Service:___

If the person is deceased please list your name, relationship to applicant and your full address and phone number.

Your Name:___

Relationship:___

Address:___

City & State with Zip Code:___

Area Code & Phone Number:___

You must enclose copies of form DD214 and Medical Records showing Agent Orange related sickness or cancer and this application. This information is critical in preparing this award. The award will Not Be Prepared without it, Nor Will You Be Contacted if a Application is sent In Lacking the Required Information

Mail To!

NANCY REKOWSKI
Assistant National Director
120 Erie Avenue
Johnsonburg, PA 15859

PH: 814-965-5760 - Email: nancyrekowski@hotmail.com

The Order of the Silver Rose Award Application can be found on their website here.

1 Comments:

Blogger Dan said...

The application does not come up when I clicked on the link. How can I get an application and submit? Thanks, Walter Retzolk

9:25 PM  

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