IWMCM - Womens veterans resource.


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Register in Illinois' Own

By filling out this form, you will be entering a name in a list of all Illinois women who served in the military or a civilian position in support of the Armed Services.

Name *

Phone Number *

Address *

City *		State *		ZipCode *

E-mail Address *

Armed Services Branch/Rate/Rank

Duty Station and Dates

Civilian Agency

Units/Dates

Yes, the IWMCM can use my name in Publications.
Yes, the IWMCM can put my photograph and story on their website.
Yes, the IWMCM can give my name to the media.

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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