| First Name |
|
| Last Name |
|
| Middle Initial |
|
| Street Address |
|
| Address (cont.) |
|
| City |
|
| State/Province |
|
| Zip/Postal Code |
|
| Country |
|
| Unit ( Trp/Sqd): |
|
| When Yr/Month to Yr/Month |
|
| Rank |
|
| Social Security Number |
|
| Work Phone |
|
| Home Phone |
|
| E-mail |
|
| If you have an E-Mail address would you
like your name listed on the find an old friend page yes or no |
|
| If someone inquires about you do we
have your permission to give them your address and phone number yes or
no |
|