Last Name:
First Name:
Middle Initial:
NickName/AKA:
Enlistment Date:
Discharge Date:
Rate and Rating (e.g. - CTRSN):
Military Status:
Active-Duty
FltRsrve-Retired
Veteran(USN)
Reserves(USNR)
Veteran(USMC)
Reserves(USMCR)
RIP
Email:
Add my email to the on-line roster also!:
Yes
No
List of Duty Stns and Comments: