2. First Name of Service Member*
3. Last Name of Service Member*
5. Rank *
6. Branch*
8. Where is the Service Member stationed? *
9. What hamlet or village does the Service Member reside in? *
   -- Select One --Amityville VillageBabylon VillageBarrier Beach CommunitiesCopiagueDeer Park East Farmingdale Lindenhurst VillageNorth Amityville North Babylon North LindenhurstWest Babylon Wheatley Heights Wyandanch
11. Upload Picture Here*

    Picture requirements: Minimum size 2” X 3”  at 300 dpi

13. Please note:

    Submitting on behalf of a family member indicates that you have their permission to share the required information with the Town of Babylon. 

15. Example of slide to be displayed on screen in the main lobby of Town Hall
    
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17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit

* indicates a required field