
Memorial Brick
At The Vietnam Veterans Memorial Beverly Hospital
Attached is the form to have a brick placed at the Vietnam Veterans Memorial at Beverly Hospital. You do not have to be a Vietnam Veterans!!!! You can honor a family member, friend, or deceased veteran. If you require any additional i formation please send us an e-mail.

This is what a finished brick will look like, 3 lines of text
You are allowed 3 lines of information
1. Name
2. Unit Served In
3. Where you served and years
4. If you have a DD214 (Military Discharge) Please sent a copy along, it will help with making sure the info is correct.
Please print clearly and check spelling, we will send you a confirmation once we have received your application to make sure that it is correct.
Please remember to include a check for $100.00
Payable to BEVERLY VIETNAM VETERANS
Note: Only 3 lines of print is allowed, see the sample enclosed, this is the max number you can place on the brick.

Application for Brick at the Vietnam Memorial at Beverly Hospital

Please Print clearly and return this form and all the others above/ If you have any questions please send us an e-mail at beverlyvietnamvets@gmail.com.

