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CONTACT INFORMATION SUBMISSION


 

Your Information

Title
First Name

  Middle Name/Initial   Last Name

Preferred/Nick Name
   
 

Please Check One:      Initial Submission      OR      Update Submission

 

If this is an update submission please enter only that information which is to be updated. Thank you.

   
 

Spouse/Significant Other                                                                                                                      (if different than above)

 First Name

  Middle Name/Initial   Last Name

Preferred/Nick Name
 

Contact Information

Street Address
Apt./Lot No.
City   State   Zip Code
Phone: Area Code   Number       Ext.
E-mail   Web Site 
 

Swenson/Military Service Information

First Tour Aboard  Swenson 19      Year Departed  19
Second Tour Aboard  Swenson 19      Year Departed  19
Highest Rank Achieved While Aboard
Did You Retire From The Navy Yes No
Retired With Rank Of
  Current/Former Occupation
What Is, Or Was, Your Occupation
Currently Retired Yes No
   
Would You Like To Receive The Quarterly Association Newsletter? Yes No
Would You Like To Receive Occasional Emails Regarding Association Events? Yes No


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Revised: 02/22/14