Bronze Order of Mercury Application

Your Rank:

POC: Your Name *

First

Last

Your Email *

Your Phone No:

Awardee Rank: *

Awardee Name: *

First

Last

Suffix:

Name for Certificate: *

Please write rank & name EXACTLY as it is to appear on the Award Medal & Certificate.
PLEASE NOTE: FULL COST OF AWARD WILL BE CHARGED FOR REPLACEMENTS AS A RESULT OF MISSPELLED NAME OR INCORRECT RANK. ($25 OFF IF MEDAL IS RETURNED)

Awardee SCRA Member ID: *

Membership is required to receive this award.

Gift Membership

No
Yes

Was a gift membership purchased for this awardee?

Awardee Chapter:

Award Presentation Date: *

This date will be PRINTED on the certificate.
A $25 Fee will be applied to awards when payment is made within 30 days of presentation date.

Award Presentation Event:

Examples: Signal Ball, Retirement Ceremony, etc.

Approval Method: *

I Have Prior Authority Approval
I Need National Board Approval

This award can be approved by any colonel (LTC,COL,BG,MG,LTG,GEN) of the Regiment who is also a member in good standing with the Association.

Approving Party Rank & Name:

Memorandum/Justification Letter (PDF preferred)

Click or drag a file to this area to upload.

Please ensure that contributions to the Signal Regiment AND the Signal Corps Regimental Association are included in the write-up.
Please see our sample memo on the BOM Award page for examples.

Additional Nomination Documentation (Optional)

Click or drag a file to this area to upload.

Delivery Option: *

Ship Award
Pick Up (Ft. Gordon/Augusta Area)

Shipping address to be provided when purchasing award

Preferred Contact Method: *

Call
Text
Email

You will be contacted via the chosen method when your award is ready.