Through Eyes of Courage- WWII Veterans registration for DVD Video version
- Use additional paper as necessary -

Veteran Information
First Name: ___________________________ MI: ____ Last Name: ____________________________
Street:______________________________ 
City:__________________ State:____________ Zip Code:_______________________________ 
Telephone: (___)________-____________________  Email:____________________
Still living: Yes_______ No________

Personal Information: (Complete as you feel appropriate - that it would contribute to the movie)
Place of Birth: ________________________________ Date:_________________
High School:____________________________ College:__________________
Civilian Employment:______________________ 
Civilian Career Occupation:_________________________

Military Service:
Branch(es) of service:______________________ Highest Rank Held: ___________________
Dates(s) of Service:_____________________ Military Specialty:____________________
Duty Location(s): ____________________________________________
Highest Medal(s) Earned:_____________________________________
Significant Information About Military Service. _________________________________________
_______________________________________________________________________________
- Use additional paper as necessary -

Person contributing this information:
First Name:______________________ Last Name:_____________________________
Street:_______________________________ City:_____________________ State:_______________
Zip:__________________
Telephone: (______) _______-_______
Relation to Veteran _________________________________________
............................   .......................... ............................... ............................................ .....................

Please complete and email to David@Davidandjudy.com
We will contact you to schedule film sessions, which will be at the Veterans Memorial Museum in Huntsville, AL.
If the veteran is not still living we will ask a family member to tell about the veteran on film.
For information contact David Carney: 256-652-2460 or David@DavidandJudy.com.
More information about us, the plays we have written and performed, the books we have written, and the videos we have produced, can be found at: www.DavidCarney.com; www.JudyCarney.com; www.DavidandJudy.com