Armed Services Recognition Form

Information to be placed on Tunkhannock Township Website - www.longpondpa.com

Name:  _________________________________________

Rank:   _________________________________________

Branch of Service:  _______________________________

Stationed at:   ____________________________________

If the service member wants to correspond with others, include mailing address or email:

Address:  ________________________________________

               _______________________________________

City, State, Zip:  ____________________________________________________

Email:  ______________________________________

Tell us a little something about him/her:

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

By signing below you are acknowledging that you are an immediate family member* and want your family member's information posted on Tunkhannock Township's website.

Signature:  _____________________________________________________

*Service person must be a Township resident