Fill out this form to be included on the plaque located in La Palma City Hall's lobby. Additional information may be requested upon submission of this form.

Please contact the Community Services Department for more information at 714-690-3356.

Name: *

Contact number:*

Address:*

Email:*

Military Branch:*

Years of service:*

Military Conflicts:*

Medals:*

Thank you for completing the Military Registration form. La Palma thanks you for your
years of service!!!