Ephrata Honors Banner Order Form PDF

For more information, please contact:
Mail completed form to:
“Ephrata Honors”
Stephanie Harley 717-875-1945 or
sharley4@ptd.net
c/o Ephrata Merchants Association
Amy MacKenzie 717-575-3982
Ephrata Honors …
Banner Program
P.O. Box 31 Ephrata, PA 17522
Make checks payable to:
Ephrata Merchants Association, “Ephrata
Honors” in the memo line
If you would like your photo returned,
please include a self addressed stamped
envelope; otherwise please send a good
copy of the photo.
Disclaimer / Release:
Photos can also be scanned as a jpeg
and emailed to:
I hereby grant the use of the enclosed /
ephratahonors@ephratavfw.com
emailed photo to the 2015 “Ephrata Honors”
To order your banner online go to:
www.ephratamerchants.com
Banner Program, without payment or other
consideration.
We will offer two opportunities to assist
I stipulate that all data is accurate, to the
you with your photo and paperwork.
best of my knowledge.
Visit us at the Ephrata VFW 141 S. State
I have secured permission form the person in
Honor a community
Street, Ephrata 733-9904
the photo (if living) to display their image and
member who serves or
has served in the
on the following dates:
•
Monday, June 1 noon - 4:00 pm
•
Tuesday, July 7 6:00-8:00 pm
military service data on a banner.
Printed Name:_________________________
Signature:_____________________________
Bring in your photo and we’ll scan it for
you and make sure the text is correct.
Date:________________________________
Ellen Rose McCarthy, USAF
US Armed Forces
Sponsored by
The Ephrata Merchants Association
and Cocalico Valley (Ephrata)
VFW Post 3376
Honor a past or present member of the US Armed Forces.
Please complete form and return with a photo of the service member you wish to honor.
Sponsorship is $160.00 per banner. There are a limited number of banners
available. We will accept orders until August 14, 2015. Proceeds from the banner
program will support the many Veteran Assistance Programs sponsored by Cocalico Valley
VFW Post 3376 & the Ephrata Downtown Holiday Lights, sponsored by the Ephrata
Merchants Association. The banners will be part of the Ephrata Downtown Banner rotation.
The unveiling ceremony will be held Sunday September 13, 2015 at 3:00 pm on Main
Street, Ephrata. More details will be provided about the ceremony closer to the event.
Sponsor’s Name ____________________________________________
Address:___________________________________________________
Phone:________________________________Email: _____________________________________
Name of Military Member as it should appear on the banner
______________________________________________________________________________
Branch of Service:____________________ Dates Served (if known):______________________
Rank (if known):____________________ Additional Data: example: Era Served, such as WWII,
Vietnam, Korea, Cold War, etc, or KIA date / location ___________________________________
Name of dedicating family as it appears on the banner
__________________________________________________________
Options: I do not know a service member, but wish to donate to the program, to offset the cost of
a banner for another family.
Name: ______________________ Donation: $______________
Businesses who sponsor a service member may be listed on the banner:
Business Name:______________________________________
Please see reverse side for additional information
Above is the Sample Banner
Size of actual banner is 42’’ x 84’’
Your Text Will Vary
based on data you supply