| Point 27

Name *

First

Last

Organization *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Type of Item Requested? (May Select Multiple Types)

Shields of Strength Dog Tags

Law Enforcement (Thin Blue Line)

Military (Joshua 1:9)

Fireman (Thin Red Line)

Dispatchers (Thin Gold Line)

Correctional Officer (Thin Grey Line)

Customs/Border Patrol (Thin Green Line)

Folded Flag Necklaces

Name of Fallen Soldier/1st Responder

NOTE: These necklaces are RESERVED For family members of Fallen Soldiers and Fallen First Responders. Includes; Parents, Spouse, Children and Siblings. In the message box below please include the name of the recipients and relationship.

Men

Women

Is A Presentation Event Planned?

Yes
No

Date / Time

Date

Time

Would You Like A Speaker?

Yes
No

Additional Information: *

Please state who the Dog Tags and/or Necklaces are for, and include Organizational affiliation of recipient. Example: Chicago Police Department, US Army, NYFD, Dallas PD 911 Call Center, San Quentin State Prison, US Border Patrol, or wife of Fallen Soldier, SFC David Jones, US Army, or Son of Fallen Officer, Corporal Jerry Smith, Dallas PD.