The National Museum of
American Jewish Military History

1811 R Street NW, Washington, D.C 20009. | 202-265-6280 | www.NMAJMH.org | nmajmh@nmajmh.org

Veteran's Name: * First Name:

Last Name:
Submitter's Name: First Name:

Last Name:
Relationship of the Submitter to Veteran:
(If Veteran is Submitter Enter "self")
E-mail: *
Telephone: *  
Address :  
Birth Date: *  
Place of Birth: City :

State:
Is He/She Deceased? Click if Yes
Death Date:
Date Entered Military Service: *  
Military Branch: *  
Highest Rank/Grade Upon Conclusion of Active Duty:  
Highest Rank/Grade Held if Reserve Duty:  
Still on Active or Reserve Duty?: Click if Yes
Date of Honorable Discharge (if applicable):
City/State from Which Entered Military Service:* City :

State:
Name of Boot Camp/OCS:  
City/State of Boot Camp/OCS: City :

State:
Other Installations/Locations at Which Served and Years:  
POW?: Click if Yes
If Yes, Where?: *
Died in Service?: Click if Yes
If Yes, Describe the Circumstances: *

NARRATIVE:Submit a personal anecdote tying in military and religious experience or an historical account of your service (limit 1000 words):

Personal Anecdote:*
Would You Like to Submit a Photo?
Do you have a live interview of your military experiences? Post it on YouTube:

If the veteran is deceased, do you wish to add his or her name to NMAJMH's Yahrzeit Program?
(Click here for more information)

Your donation to the NMAJMH will ensure the stories of our brave Jewish veterans are available to future generations.

Would You Like to Make a Donation? Click if Yes
Get Acrobat Reader