Keeper of the Flame Award Nomination (revised 03/2017)
Submission Instructions: Complete and print below nomination formSubmit through chain of command for required signatures Mail nomination form with correct payment Confirm receipt of nomination form 7 days after submissionAll awards are mailed to the nominator unless otherwise specified!!
Please mail or fax the below form to: U.S. Army Ordnance Corps Association P.O. Box 5251 Fort Lee, Virginia 23801 Telephone # 804-733-5596 Email: [email protected]
AWARDEE
NAME:
Rank /Title:
Organization:
Address:
Address:
NOMINATOR
City:
State:
NAME:
Rank /Title:
Organization:
Work Phone:
NAME:
Rank /Title:
ENDORSER
Organization:
Email address:
Signature:
Email address:
Signature:
APPROVAL AUTHORITY
NAME:
Rank /Title:
Organization:
Signature:
City:
State:
1
NOMINATED INDIVIDUALS SIGNIFICANT CONTRIBUTION TO THE U.S. ARMY ORDNANCE CORPS (MAXIMUM OF SIX BULLETS)
2
Keeper of the Flame Award Nomination Payment Method
Make Check / Money Orders payable to: USAOCA
Pleases charge my: for:
Expiration Date:Credit Card number:
code number: (3didgit code located on the back of credit card)
Name on the Credit Card:
SIGNATURE: DATE:Your signature is required for Credit Card purchases
I have enclosed a Check / Money Order for the amount of :
Please check one of the following Payment Methods
( we must have credit card code for processing )
/
3
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