Akwesasne Veterans Memorial Monument Phase II
Memorial Order Form
We invite you to purchase an engraved memorial in memory of your
Akwesasne loved one(s) who honorably served in the United States or
Canadian Armed Forces
Veteran $50.00
Each additional name $25.00
1) Rank/Name/Branch Year: _____________________________________________________
2) Rank/Name/Branch Year: _____________________________________________________
3) Rank/Name/Branch Year: ____________________________________________________
Example: SSGT John Cook USMC Vietnam ‘60- 66
LT. Tom Thompson US Army Iraq ’03- ‘11
This information will be on one line on either a memorial brick or panel.
For more information, please contact the Saint Regis Mohawk Tribe Communications
Department at (518)-358-2272 or email: communication@srmt-nsn.gov
Payment can only be made in the form of Check or Money Order
Please make out to: Saint Regis Mohawk Tribe
c/o Akwesasne Veterans Memorial Monument Project
412 State Route 37
Akwesasne NY 13655
Name: __________________________________
Address: ________________________________ *Amount paid: _________________
Phone: _________________________________ #0001