1.

Proof (Service Record) by mail or fax of documents showing that you served during these time periods:    

a.  1 Can Para Bn from 1942-45

b.  First Special Services Forces 1942-1944

c.  Special Air Service 1947-1949

d.  Mobile Striking Force 1948-1958

e.  Defence of Canada Force 1958-68

f.  Cdn Airborne Regt & Battle Group 1968/1995

g.  Airborne School & CFPMD

h.  Jump Companies

Require form from your DND service called “Member’s Personnel Record Resume” or the

“UER Employment History Record (CF743D)”

2.

For replacement coins..........Do you know the number of your coin?  If yes, #_______________

3.

Your Military Service Number is needed as supporting documentation.  This information is used for

identification purposes only.  It is also needed if you need a replacement coin and cannot remember your

original coin number.

Military Service Number # ___ ___ ___ - ___ ___ ___ -___ ___ ___

4.

Full mailing address with Telephone number.

___VISA   ___MasterCard  ___Money Order (Payable to Joe Drouin Enterprises Ltd)

Card No. _______________________________Exp. Date ___/___ Signature _________________________ 

Name:_____________________________ Telephone #(_____)_____-_______ Fax #(_____)_____-_______

Address: ________________________________________________________________________________

            _________________________________________________________________________________

E-mail: __________________________________________________________________________________

5.

Quebec:   $25.00 coin + $6.75 Postage + $1.59 GST + $2.50 QST = $35.84

Ontario:   $25.00 coin + $6.75 Postage + $1.59 GST = $33.34

PEI, BC, AB, SK, MB, NWT:   $25.00 coin + $10.25 Postage + $1.76 GST = $37.01

NS, NB, NL:  $25.00 coin + $10.25 Postage + $4.58 HST = $39.83

Which must be sent in advance either by money order or Visa or MasterCard.

6.

Your last name and original number will be engraved on the coin. Each coin will

come in a clear plastic pouch and with a blue insertable card describing the challenge.

7.

Please forward by fax or mail the documentation that you have served as outlined in "item 1" plus the

information required in "items 2, 3, 4 and 5" to the following address.