Inscription Form

2. 
3. Verde Valley Military Service Park at Garrison Park
5. Inscription Application

   The Verde Valley Military Service Park honors those citizens of the Verde Valley area who have honorably served in the United States Military. All five branches of the Military are represented. Proof of military service and Verde Valley residency (or residency of loved one) will be required with your application (Cottonwood, Clarkdale, Camp Verde, Sedona, Jerome, Rimrock, Cornville, Verde Village, Lake Montezuma, Big Park). Acceptable forms of documentation include a copy of DD Form 214 (or for other acceptable options ‐ see below) and a letter of residency. Letter of residency should include the address and years the veteran, or family member, resided in the Verde Valley and does not require notarization or references. (Please note that once validated, all DD‐214 forms and other forms used for verification will be shredded and destroyed).  Please complete this form and return with payment to the City of Cottonwood, c/o Military Service Park, 150 S 6th Street, Cottonwood, AZ 86326. Each inscription may have one line of text (veterans name only). Rank will not be included. Placement of the inscription on the Military Service Recognition Wall will be determined in the order in which purchase is received. This is a non‐refundable order. 

7. Please complete the following required information for the inscription layout:
9. Name of Veteran*
11. Which branch of the military did you/he/she serve:*

13. PLEASE NOTE - After submitting this application, you will still need to submit your DD-214 form (or other qualifying document) to the Cottonwood Parks and Recreation team for review before payment or approval. 

17. Required Information to Process:
19. Your Name:*
20. Phone Number:*
22. Mailing Address:*
24. City, State, & Zip Code *
25. Email:*
29. Payment Information

    A $75 payment should accompany each inscription. Payments can be made in person at the Cottonwood Recreation Center, over the phone, online, or by check made out to the City of Cottonwood and mailed to 

    Cottonwood Recreation Center 

    150 S 6th St, Cottonwood, AZ 86326

    MEMO Line- Military Service Park Inscription 

    PLEASE NOTE - Inscriptions will be placed on granite monuments on an as-needed quarterly basis. Please get in touch with Cottonwood Parks and Recreation staff if you would like to know the next inscription deadline. Thank you. 

33. Monetary Donations

    Donations made strictly for the benefit of the park, not for the purpose of an inscription, are also accepted. Park Bench inscriptions are also available for purchase through donations. Please contact Cottonwood Parks and Recreation staff if you are interested in this type of donation at (928) 639‐3200 x3208. 

37. DD Form 214: In the event that you are unable to provide or acquire this form, staff can guide you through alternate forms of verification that are sufficient in proving the veteran was in fact Honorably Discharged from the military. Example: Alternate forms of proof may include but are not limited to a VA Card or United States of America Certification of Military Service form. (Please also note that after verification, all DD‐214 forms or alternate forms of proof will be destroyed). 

39. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
41. Electronic Signature
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field