Military Banner Program Application

Military Banner Program

Please complete the form below.
If you do not wish to provide your information online, hand-write your information on a printed copy and mail to

City of San Bernardino
290 North D Street
San Bernardino, CA 92401

Please note that the rank of the service person will not be used.

*A previous version of this form had the ability to submit an attachment. This function was not working properly. Any previously submitted attachments were not received. We hope to have this functionality restored in the future.

Program Application Form

Name of Military Service Person:

* First Name
* Last Name
* Branch of Military Service:
* Date of Enlistment
* Anticipated Date of Discharge:

Name and Address of Contact Person:

* Name (First & Last)
* Address:
* City
* Phone:
* Relationship to Service Person:
* State:
* Zip Code:
* Email

Make check payable to: City of San Bernardino

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