Website Biography Registration Form


    Name Last    Name First   MI 

    Home Address   

    City   State   Zip

    Phone #     Cell #   

    Email   please give us a way to contact you if we have questions.
                 all blocks will expand to hold all of your information.

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    What I did back Then - Military  History 

                                                                                            From                                             To
   Years you served in the 68th AHC :        month  year    -  -  -   month year    
    
   Primary Duty in the 68th AHC     

   Other Duties in the 68th AHC   

   Rank upon arriving in the Unit     Sp-4, WO1, Enl., Off., Etc.

   Rank upon departing the Unit       Sp-4, WO1, Enl., Off., Etc.
                                                                                                                           
   Did you retire from the military?      Yes     If yes fill in the 3 blanks below: 
 
           Service
       Date              Rank 
                         
Army, Navy, etc.          date discharged  (month/year)                 Sp-4, WO1, Enl., Off.

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    List the Duty stations including military training:   Examples:  (Ft Hood Basic,  Ft. Rucker  Crew Chief, 
    Ft. Wolters  Pilot list class #, Germany,  Company Commander, Ft. Dix Drill Sgt.  List all. )

      
     This block will expand to hold all of your information.
    
   Did you serve more than one tour in Vietnam?      With what unit?     
   Dates:    From    month
  year    -  -  -  To:  month year
   Primary duties"  

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    What are you doing Now!

    Current Residence: if different from above:    City   State

   
Occupation: 
    
This block will expand to hold all of your information.  Tell what you have been doing since the Army days.

    Family:     

                      
This block will expand to hold all of your information.    
    Hobbies:  


    Email:
if different from above: 

     Remarks: 
                        This is an unlimited space, just keep typing if you fill the box above.                    

Please click the   Submit  button only once!

Form  10-03-2007

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