Fifties Frogs Questionnaire (Build 2/22/06 1042) Build date and number refers to date and time of last editing/modification of this form. Always refresh your browser.

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Military Service
Personal/Family
Civilian Profession

Note: Info will also be used to write your biography


military

MILITARY SERVICE INFORMATION
* required

First Name: *
Last Name: *
Middle Name/Initial:
Nick Name:
Highest Rank/Rating:
Total Years of Service: 

Date you Entered Service:       
Date you Retired from Service:

UDTRA Class/BUD Number:     *

Branches, Ships, Stations, Teams/Units Served With:*
 

p


personal

PERSONAL/FAMILY INFORMATION

Home Phone:     *
E-mail Address:
FAX:                
 

Family/Marital Status: (click arrow for choices)

Your age:

If married/remarried, your wife's full name:

Number of years married:

Number of children:

Enter other family member names: (children/grandchildren, siblings etc.)

c


civilian

CIVILIAN OCCUPATION PROFESSION INFORMATION

Civilian Occupation/Profession

Occupational/Education Degree/Titles:

Years spent in Civilian Business/Profession:

Enter anything else you'd like us to know:

 

Share with us one of your sea stories? (please)

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