THE UNITED STATES OF AMERICA
VIETNAM WAR COMMEMORATION

Civilian Application

Privacy Act Statement

AUTHORITY: 10 U.S.C. Section 113 note (Public Law 110-181, div. A, title V, Section 598, Jan. 28, 2008, 122 Stat. 141), Program to Commemorate 50th Anniversary of the Vietnam War.

PRINCIPAL PURPOSE(S): Multiple organization points of contact and contact information are necessary to allow DoD to communicate with the organization. The timeframe of the commemoration lasts 13 years.

ROUTINE USE(S): Any release of information outside the DoD will be compatible with the purpose(s) for which the information is collected and maintained. The DoD Blanket Routine Uses found at http://dpclo.defense.gov/privacy/SORNs/blanket_routine_uses.html may also apply to this collection. Applicable SORNs: None. Records are retrieved only by organization name.

DISCLOSURE: Voluntary. However, failure to provide requested point of contact information may adversely affect the organization's acceptance as a commemorative partner.

Instructions

To apply to become a Commemorative Partner, please fill out the following information in as much detail as possible. Please type or print clearly.
Steps:
1. Use this form to list your organization's name and provide the names, addresses, email and telephone numbers of your committee's chairperson and point(s) of contact (POC).
2. Use Page 2 of this form to list the members of your Commemorative Committee. You may add as many as you like, but we require at least three members.
3. Use the Submit button at the bottom of this form to email your application to: WHS.VNWAR50th_CPP_CIVAPP@mail.mil.
fax to: 703-692-4691, or mail hard copies to:
The United States of America Vietnam War Commemoration, Suite 810, 1101 Wilson Blvd., Arlington, VA 22209.

Commemorative Partner Program Application - STEP 1

Civilian Organizations Application


Name

Phone Number (Format: 123-456-7890)

Street (Include Suite Number)

Country

State/Region

City

Zip Code

Committee Chairperson

Name

Email Address

Telephone Number(s) (Include Area Code)

Street (Include Suite Number)

Country

State/Region

City

Zip Code

1. Point of Contact

Name

Email Address

Telephone Number(s) (Include Area Code)

Street (Include Suite Number)

Country

State/Region

City

Zip Code

2. Point of Contact

Name

Email Address

Telephone Number(s) (Include Area Code)

Street (Include Suite Number)

Country

State/Region

City

Zip Code

3. Point of Contact

Name

Email Address

Telephone Number(s) (Include Area Code)

Street (Include Suite Number)

Country

State/Region

City

Zip Code

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