Please fill up information concerning the person to be enrolled

Fields marked with an * are required

Prefix First Name * Middle Name Last Name * Suffix
 
Birth Date * ex ("mm/dd/yyyy")
Death Date ex ("mm/dd/yyyy")
Check here if death occured before sunset
Check here if person is to be preregistered
Bio - Cost is $100 for up to 150 words and 70¢ for each additional word
Total Charge:   
 
Check here to show Yahrzeit on the internet
 
JWV Service  
  Highest JWV Position
  Post or Auxiliary
 
Military Service  
  Service
  Corps/Specialty
  Service Begin Date ex ("mm/dd/yyyy")
  Service End Date ex ("mm/dd/yyyy")
  Rank
  Medals and Citations
 
Sponsor check Notify to receive a letter on each anniversary
Prefix  First Name * Middle Name  Last Name * Suffix
Street Address *  Apt No      Phone                    Relationship * Notify
        
City * State *       Zip Code *           Email Post/Aux
     
 
Type the number of next of Kin you need in the box and click ADD   
 
Yahrzeit Image  
Please click here to email a picture as attachment in a  .jpg or  .gif format and any questions or concerns to Mary Westley
Check here to have the picture displayed on the internet

June 19, 2013 08:07 EST
Washington, DC, USA
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