Veteran Registration

The registration fee is $250.00.  You will receive a link to pay online after your submission, both on this website, and also a link that will be sent to your email.

If you registered a Veteran but still need to submit a bio and/or photo, please use the form below or email your information to 

Please note:  If you register after October 22, 2023 – the Veteran will be on our next engraving in Spring 2024.  Thank you! 

    Veteran Information:

    WWIWWIIKorean WarVietnamGolf WarPanamaSomaliaGrenadaDesert StormGlobal War on TerrorIraqAfghanistanPeacetime

    ActiveReserveHonorably DischargedRetiredKilled in ActionKilled in ServicePOWMIA

    ResidentFamily Member of ResidentBusiness OrganizationService OrganizationOther



    I warrant that the information submitted to the Clarence Veterans Memorial is accurate and complete in all respects. I acknowledge that the information provided will "literally" be carved in stone, and that any changes after the original engraving will be the responsibility financially of the sponsor. This includes any factual errors discovered by outside parties. I acknowledge that the Clarence Rotary Foundation and the Clarence Veterans Memorial will not be responsible both physically and financially for any errors of information submitted through this form.

    I have reviewed the information contained herein, and represent that it is factually true, accurate and complete. I understand that the Clarence Rotary Foundation and the Clarence Veterans Memorial may use the information I provided for public records, advertising opportunities, and promotional opportunities. The above terms and conditions will become effective and be binding upon and enforceable upon submission of the information.

    By checking this box, I agree to submit this application electronically and understand that an electronic signature has the same legal status and can be enforced in the same way as a written signature.