Attention Purple Heart Recipients and family
members of all military hospital
patients:
Did a medic, hospital corpsman, helicopter
medevac or
hospital ship crew, armed forces doctor or nurse, MASH
Unit, battlefield stretcher bearer, battalion medical aid
station, or military ambulance personnel save your life, or
perhaps provide critical emergency medical care to one of
your family members? If so, within 30 days we need to
have your service-connected medical memoir (300-500
word military medical “war story”) submitted to our
archives for publication in a series of books, as a tribute
of appreciation to the medical personnel of all branches of
the military and serving in any theater of operations during
all wars or conflicts that provided you with necessary or
critical medical care, even if your service connected illness
or injury was not sustained from being wounded in action.
The proceeds from the book sales are dedicated to help
build the Combat Medical War Memorial and Youth
Education Center.
********************************************
Name_______________________________________
Address
_____________________________________
City
_________________ STATE ____ Zip_____+_____
Phone
(____)____________________________
Email ________________
@________________ . ___
Please attach your self-addressed stamped
envelope for
us to return any military or current photographs that you
may provide with your “war story.” If the story of your
military medical memoir is selected for publication you
will receive the book your medical “war story” appears in
FREE. Please circle status below:
Veteran Wounded In Action
Relative of any Wounded In Action Military Personnel
Veteran of Military Medical Corps
Relative of any Military Medical Corps Personnel
Name of your relative that was a Military Patient, if not
yourself:
_____________________________________________
Military Service Number
_______________________
Branch _________________________
Medals ________________________________________
Rank ________ Years Served
_________ to _______
Military Hospital/Medial Facility __________________
War, Conflict, Theater of
Operations, Ship or Duty Post:
______________________________________________
Your Family Info: Number
of: _______ Children
_______ Grand
Children ______ Great Grand Children
Veterans please indicate the Veteran’s Organizations that
you are affiliated with:
[ ] Veterans of Foreign
Wars [ ]American Legion
[ ] Order of the Purple
Heart
[ ] AmVets
[ ] NGAUS
[ ] Veterans of the
Armed Forces
[ ] Viet Nam Veterans of
America
[
]Other____________________________
PLEASE
PRINT THIS PAGE AND SUBMIT YOUR
TRUE MEDICAL WAR STORY BY MAIL OR FAX TO:
National Medical
War Memorial
6 NE 62nd Place, Kansas City, MO 64118-4140
For Electronic Mail please provide the
information
above and include your story in the TEXT of the email.
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