Sua Sponte Membership Roster Data Form

Please help keep our Association records updated. Information will be used only for mailing out the newsletter and keeping members in contact with each other.  By providing this information you help us keep locating and mailing costs down. Thank you. 

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First name:   Middle initial:   Last name:

Street address:

City: State: Zip code:

Date entered unit in Vietnam:   Date left unit in Vietnam:

E-mail: Code Name:

Home phone w/ area code:   Work phone w/ area code:

Comments:

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