Application Date: (example: mm/dd/yyyy)

Check One: I am the service member My Spouse is the Servicemember

Applicant’s Last Name: First Name:

Rank: Branch of Service: Unit:

Email:

Spouse’s First & Last Name:

PHONE NUMBERS (For shipping purposes, must provide home number and cell phone, if applicable.)

Home Phone: Cell Phone:

Home Residence Address/City/State: (NO APO or P.O. BOX adresses accepted. Packages will be delivered via Fed Ex with Signature Required.)
Street Address:
City: State: Zip Code:

(Reminder – To qualify for this offer, Military Member must be stationed out of or from Illinois)

Current Location Serving in Iraq or Afghanistan:

If not currently deployed, dates you were deployed:

Date of Your Wedding:

Name of Wedding Location (Church or Event Space):

Address of Wedding Location:

Below is a sample image of the “Toast to the Troops” design that will be engraved, identically,
on one side of each crystal goblet; as well as a sample of the branch of service emblems that will be
assigned to each glass according to the information you provide on your “branch of service”:

Please indicate how you would like your names to appear on the dog tag: