Field of Heroes Flags -

Name of Flag Purchaser or Sponsor *

Contact Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Flag Display Location *

Glendora City Hall
Sunflower Location

(Only the first 100 requested will be displayed at City Hall)

Name/area of service on Sponsored Flag: *

(i.e.: Lt. James Smith, U.S. Army, or Capt. June Smith, Glendora P.D.)

Message on Flag Tag (limit 60 characters) *

Flag Purchase Details

Individual Flags: $50.00 per flag and will be displayed commemorating a Veteran, Military Member, First Responder, or Healthcare Hero of your choosing.

Flag Order Form

1 x Flag: - $ 50.00
2 x Flags: - $ 100.00
3 x Flags: - $ 150.00

Please choose

Any Amount Donation $

Notes:

Payment Method *

Credit Card Below
I will send a check. (Send To Glendora Rotary: PO BOX 776, Glendora CA 91740)

Total

$ 0.00

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Card

Name on Card