On-Line Version, Page 1
(Click for Print Version in PDF Format))
The Tour(s) data is requested on the next page to assist Locators & Historians document the Advisory effort in SE Asia for
future generations. Your name, address, telephone and e-mail are required to ensure we can contact you as necessary.
Your Personal Information
Name:
Street Line:
City, State & Zip:
Email:
Phone:
[ Format must be NNN-NNN-NNNN ]
How do you prefer to be contacted if needed by Counterparts?
Personal Data Restrictions
Include in Print Member Directory
Do Not Include in Print Member Directory
Include in Member Only Web Site Area
Do Not Include in Member Only Web Site Area
Army Dist Svc Cross, Navy Cross, Air Force Cross,
Coast Guard Cross
MOH
Medal of Honor
AUS, KOR, PHL, ESP, NZL, RVN, THA, TWN Combat Medals & Citations Awarded to You
Include all from a country on one line. Separate honors & citations with a comma.
Country
Abbreviation or Name of Citation
I, the undersigned applicant, certify that this information is true and correct to the best of my knowledge
and that my service in Southeast Asia
was honorable. I authorize the Association to verify my eligibility.
I support the principles and camaraderie of the Association.
Your Initial Dues Payment and US Form DD214 or Non-US equivalent are required to be mailed
to complete your application.
