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2. CITY OF COHOES HOMETOWN HEROES
4. Please complete this application form, including the service's person's name and branch of service (Army, Navy, Air Force, Marines or Coast Guard). Include proof of Cohoes Residency and proof of Military Service (e.g. Military ID or DD 214) Each banner is $250.00. Banners will be located in Veteran's Memorial Park on Columbia Street.
6. Service Person's Information
8. First Name*
9. Last Name*
11. Suffix (if any)*
12. Specify the Branch of Service & Division (if known)*
14. Era of Service*
18. Sponsor Information
20. Sponsorship informaiton to be printed on the Banner*
22. First Name*
23. Last Name*
25. Relationship*
27. Address*
29. Telephone Number:*
30. Email address*
32. Proof of Cohoes Residency *
    e.g. Driver's license, utility bill, tax bill
33. Proof of Military Service*
    e.g. Military ID or DD 214
35. High Resolution Photograph*
    A JPEG file with 150dpi resolution (there must be NO other people in the photo)
37. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
39. Electronic Signature
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field