U. S. Space Walk of Fame Foundation

Commemorative Engraving Order Form

SWOF is currently accepting orders for engraving of Space Workers names on the Mercury, Gemini, Apollo and Shuttle Monuments of the U. S. Space Walk of Fame.

To have a name engraved on a monument does require the space worker to have been employed to work on the specific space program for which the monument represents.

Name of Space Worker to be engraved _______________________________________

Name of the Monument to put name on _______________________________________

Name of employer during time of the program _________________________________

Name of the facility or location worked at during the program _____________________

From ______________________________________ Date ________________________

Address ___________________________________ Phone _______________________

City _________________________ State __________________ Zip ________________

E-Mail Address __________________________________________________________

Signed ____________________________________
                 I hereby affirm the name to be engraved belongs to a Space Worker who worked on the subject program.

Please Print out and
Send the completed form and funds in the amount of $100.00 payable to:

The U. S. Space Walk of Fame Foundation
P. O. Box 1989
Titusville, Florida 32781-1989
Please do not write below this line.