Illinois Women's Military and Civillian Memorial
P.O. Box 519
Bloomington, IL 61702-0519
Phone: (309) 451-4896

1. Name

2. Phone Number

3. Address

4. Your email Address

5. City 6. State 7. ZipCode
8.Armed Services Branch/Rate/Rank

9. Duty Station

10. Civilian Agency

11. Units/Dates

Yes, the IWMCM can use my name in Publications.
Yes, the IWMCM can give my name to the media.
12. Additional Notes

* Required Field

If you would like to make a charitable contribution to the IWMCM please make your checks payable to:
Illinois Women's Military and Civilian Memorial
P.O. Box 519
Bloomington, IL 61702-0519


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