Veterans Memorial Commission, Jamestown, New York

Chautauqua County Veterans Memorial Commission Database Enrollment Form

Please enter your information and submit the form below or you can click here to download and print the pdf enrollment form.

 


Fields labeled in red are required.
Fields labeled in blue will not be displayed on our website.

 

Veteran Personal Information
First Name
M.I.
Last Name


Veteran Military Service
Date of Enlistment
mm/dd/yyyy
Branch
War
Unit
Rank
highest rank achieved
Places Served
Type of Duty 
military occupation
Killed In Action (KIA)
Yes No
Prisoner Of War (POW)
Yes No
Missing In Action (MIA)
Yes No
Wounded In Action (WIA)
Yes No
Awards, Medals, Commendations
Other Information
Date of Discharge
mm/dd/yyyy
Town or City of Residence
Information Source
Name, relationship, phone number

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