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RangerMemorial Purchase a Stone Purchaser InformationName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* Ranger's InformationName* First Middle Last (20 Characters or less including spaces)Limit unit to Appear (20 Characters or less including spaces)* Click here for a list of appropriate unit designationsCommentsQualification CriteriaCheck any that apply Graduate of the U.S. Army Ranger School Served in a provisional or operational LRP/LRRP company during the Vietnam War Served in an operational Ranger unit during peace or wartime Attached to Ranger Unit during combat operations Awarded the U.S. Army Ranger Tab by General Executive Order for: World War II Ranger Battalions Merrills Marauders (5307th Composite Unit-Provisional Ranger Infantry Companies (Airborne) of the Korean War Proof of Service:Check any that apply DD Form 214 Ranger School graduation diploma Special orders awaiting Ranger qualification or service with a Ranger unit Please upload a copy of the above Proof of Service here: Drop files here or Select files Max. file size: 200 MB, Max. files: 5. Payment InformationPayment Method*Chose a Payment MethodCredit CardMemorial Stone (Pay By Check)Credit Card*Card Details Cardholder Name Total $0.00 The information I've provided on this form is correct to the best of my knowledge. I understand that knowingly and willfully providing a false statement or misrepresenting the qualifications of the individual to be engraved on the National Ranger Memorial Foundation Monument is a violation of Georgia Code 16-10-20 and Section 1001, Title 18, U.S. Code and subjects me to prosecution punishable by a fine, imprisonment, or both. Individual stones cost $350.00 and can be paid for on-line with your credit card. You will be notified of your acceptance through a return e-mail confirmation. National Ranger Memorial Foundation, Inc. P.O. Box 53369 Fort Benning, GA 31995* Checking this box means you agree with the following: The information I've provided on this form is correct to the best of my knowledge. I understand that knowingly and willfully providing a false statement or misrepresenting the qualifications of the individual to be engraved on the National Ranger Memorial Foundation Monument is a violation of Georgia Code 16-10-20 and Section 1001, Title 18, U.S. Code and subjects me to prosecution punishable by a fine, imprisonment, or both. Individual stones cost $350.00 and can be paid for on-line with your credit card. You will be notified of your acceptance through a return e-mail confirmation. National Ranger Memorial Foundation, Inc. P.O. Box 53369 Fort Benning, GA 31995CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.