VIETNAM WAR COMMEMORATION
COMMEMORATIVE PARTNER PROGRAM APPLICATION
(Civilian Organizations only)
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. Section 113 note (Public Law 110-181, div. A, title V, Section 598, Jan. 28, 2008, 122 Stat. 141), Program to Commemorate
50th Anniversary of the Vietnam War.
PRINCIPAL PURPOSE(S): Multiple organization points of contact and contact information are necessary to allow DoD to communicate with the
organization. The timeframe of the commemoration lasts 13 years.
ROUTINE USE(S): Any release of information outside the DoD will be compatible with the purpose(s) for which the information is collected and
maintained. The DoD Blanket Routine Uses found at may also apply to this
collection. Applicable SORNs: None. Records are retrieved only by organization name.
DISCLOSURE: Voluntary. However, failure to provide requested point of contact information may adversely affect the organization's acceptance as a
commemorative partner.
INSTRUCTIONS
To apply to become a Commemorative Partner, please fill out the following information in as much detail as possible. Please type or
print clearly.
Steps:
1. Use this form (DD Form 2954 for military installations) to list your organization's name and provide the names, addresses, email
and telephone numbers of your committee's chairperson and point(s) of contact (POC).
2. Use Page 2 of this form to list the members of your Commemorative Committee. You may add as many as you like, but we
require at least three members.
3. Use the Submit button at the bottom of this form to email your application to: WHS.VNWAR50th_CPP_CIVAPP@mail.mil.
fax to: 571-256-3389, or mail hard copies to:
The United States of America Vietnam War Commemoration, Suite 810, 1101 Wilson Blvd., Arlington, VA 22209.
1. ORGANIZATION
a. NAME
b. TELEPHONE NUMBER
(Include Area Code)
c. MAILING ADDRESS: (1) STREET
(2) CITY
(3) STATE
(4) ZIP CODE
(Include Suite Number)
2. COMMITTEE CHAIRPERSON
c. TELEPHONE NUMBER(S)
a. NAME
b. EMAIL ADDRESS
(Include Area Code)
d. MAILING ADDRESS
(1) STREET
(2) CITY
(3) STATE
(4) ZIP CODE
(Include Suite Number)
3. POINT OF CONTACT
a. NAME
b. EMAIL ADDRESS
c. TELEPHONE NUMBER(S)
(Include Area Code)
d. MAILING ADDRESS: (1) STREET
(2) CITY
(3) STATE
(4) ZIP CODE
(Include Suite Number)
4. POINT OF CONTACT
a. NAME
b. EMAIL ADDRESS
c. TELEPHONE NUMBER(S)
(Include Area Code)
d. MAILING ADDRESS: (1) STREET
(2) CITY
(3) STATE
(4) ZIP CODE
(Include Suite Number)
5. POINT OF CONTACT
a. NAME
b. EMAIL ADDRESS
c. TELEPHONE NUMBER(S)
(Include Area Code)
d. MAILING ADDRESS: (1) STREET
(2) CITY
(3) STATE
(4) ZIP CODE
(Include Suite Number)
DD FORM 2953, NOV 2014
Page 1 of 2 Pages
If additional committee members, list on Page 2.
PREVIOUS EDITION IS OBSOLETE.
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