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2. Contact Name*
4. Address1*
6. City*
7. State
8. Zip
10. Phone Number*
12. Email*
14. Hometown Hero Full Name *
16. Purple Heart / Bronze Star / Silver Star Recipient?
17. My Hometown Hero is Proudly Honored by (i.e. The Smith Family)*
19. Years/Era of Service
20. Eras of Service
    • World War I: April 6, 1917 - Nov. 11, 1918
    • World War II: Dec. 7, 1941 - Dec. 31, 1945
    • Cold War: Sept. 2, 1945 - Dec. 26, 1991
    • Korean Conflict: June 27, 1950 - Jan. 31, 1955
    • Vietnam Conflict: Feb. 28, 1962 - Nov. 7, 1975
    • Persian Gulf War: Aug. 2, 1990 - Aug. 31, 1991
    • Global War on Terror: Sept. 22, 2001 - Present
22. Would the applicant like the banner provided to them at the end of the display period?*

    1. Yes
    2. No
23. Please Submit:

    A high–resolution photograph of the honored Veteran in military uniform.    ** Photos in military uniform are preferred but not required.

    Physical photos can be mailed to the Village Hall. 

    By mail: Village of Homer Glen Attn: Dan Waddick  14240 W. 151st St. Homer Glen, IL 60491 

24. Submit picture here *
26. How will you submit payment?*

    1. Online (Credit Card)
    2. Check

    Fee is $175. Online payment with a credit card is available on the Hometown Heroes Banner website page. For checks, please make check out to Village of Homer Glen.

28. For all questions and inquiries:

    Please contact the Events Department at 708-301-0632 or email events@homerglenil.org.

30. Photo Release Acknowledgement (Check box to accept)

    1. I HEREBY GRANT THE VILLAGE OF HOMER GLEN, IL PERMISSION TO USE THE ATTACHED PHOTO IN THEIR HOMETOWN HEROES MILITARY BANNER PROGRAM, WITH THE UNDERSTANDING THAT THIS PHOTO, OR ITS LIKENESS, MAY BE USED FOR THE VILLAGE’S PROMOTIONAL USE. I ALSO UNDERSTAND AND HOLD THE VILLAGE HARMLESS FOR ANY SUBMITTED INCORRECT INFORMATION, OR ANY “ACTS OF GOD” OR VANDALISM THAT MAY DAMAGE OR DESTROY ANY SPONSORED BANNER. THE VILLAGE RESERVES THE RIGHT TO APPROVE ALL BANNERS, AS IS A SPONSORSHIP, NO REFUNDS.
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field