To Reserve your loved one's star for free: Please print and complete this form and mail a wallet size photo: (PHOTOS CAN BE RETURNED)

Blue Star Mothers Inc.
NY Chapter #1
PO Box 426
Bloomfield, NY 14469

Your Name:

Your Address:

Your City/State/Zip:

Phone:

E-mail:

To Honor:

Branch of Service and Rank:

What Color Star? Blue: Has or is Serving; Gold: KIA; Silver: Wounded; Black: MIA/POW

Will You be attending the Ceremony on December 1, 2013 in Kershaw Park?