New Member Attendee Form

Personal Information

Last name *   First name *   Date of birth

Spouse's Last name   Spouse's First name

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Contact Information

Address   Address 2

City   State TX AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN UT VT VA WA WV WI WY   Zip Code

E-mail address

Cell phone   Home phone   Work phone

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Veteran Information

Are you a veteran? (if no please skip to additional information)
Yes
No

Gender Male Female

Ethnicity American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiin or Pacific Islander White Other  

Are you a disabled Veteran (rated through the VA)? Yes No

Dates of Service
From: To:

Branch of Service
US Air Force
US Army
US Army Air Corps
US Coast Guard
US Marine Corps
US Navy
US Space Force

Era of Service
WWII
Korea
Vietnam
Cold War/Peace Time
GIA (Gulf War, Iraq, Afghanistan)

Rank at discharge

Division/Unit/Assignment

Battles/Engagements

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Additional Information

If you are not a veteran, please let us know how you are affiliated with Roll Call.
Family member of veteran
Friend of veteran
Visitor
Other (see notes below)

Notes

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Emergency Contact

Name   Relation to you

Address   Address 2

City   State TX AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN UT VT VA WA WV WI WY   Zip Code

E-mail address

Cell phone   Home phone   Work phone

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