Dallam-Hartley Counties
    Veterans Memorial
    C/O: XIT Museum
    P.O. Box 730
    Dalhart, Texas 79022

    Phone:
    806.244.5390

    Nick Olson
    Committee Member

    Mark Welch
    Committee Chair
    -------


The purpose of the Veteran's Project is to gain information on Veterans of Dallam and Hartley Counties in order to be as inclusive as possible in our memorial. By sharing your name and story with the XIT Museum, not only will you assure yourself or the veteran in your life a place in the memorial, but you will also be sharing your story with future the generations of Dallam and Hartley Counties. Please fill out the contact form below or contact us at the address/phone to the left.
-------


    1. Veteran Name: 

    2. Veteran Address: 

    3. Telephone Number: 

    4. If Completed by someone other than Veteran: 

    5. Is this veteran classified as MIA?: 

    5a. When classified as MIA?: 

    5b. Is this veteran classified as KIA?: 

    5c. When classified as KIA?: 

    6. What Branch(s) of service?: 

    7. Date of Birth: 

    7a. Place of Birth: 

    8. Means of Entry:
    Enlisted  Inducted  Commissioned

    9. Comments concerning entry:

    10. Date(s) of entry: 

    11. Date(s) of discharge: 

    12. Place(s) of discharge: 

    13. Rank(s) at discharge: 

    14. Military occupational specialties or qualifications:

    15. Service (Vessels or areas of service):

    16. Battles or campaigns:

    17. Decorations and Citations:

    18. Were you ever classified as a POW?:
    Yes  No

    19. If so, where and when?:

    20. Would you be willing to discuss your experience while in service?:
    Yes  No

    21. If yes, through a questionaire?:
    Yes  No

    21a. Or interview?:
    Yes  No

    21b. Or both?:
    Yes  No

    22. Would you be willing to donate items to the XIT Museum for exhibit or archive purposes?:
    Yes  No

    22a. Or allow items to be copied?:
    Yes  No

    22b. Donation comments:

    23. Additional comments:

    24. How may we contact you?:
    E-Mail
    Postal Mail
    Telephone

    25. E-Mail Address: