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We ask that you thoroughly complete the blanks on this page and the military history form (page 3 and 4). The data will be used, in part: to augment articles in an Association quarterly newsletter; to allow identification of membes who may have been involved in unique situations considered appropriate for publication, such as those who served at a particular location together during a certain period; and, in the event of death, to provide the basis for an accurate obituary. Qbviously, a phone number provides timely access for update of information, as necessary, and the home phone number will appear in the diretory if you authorize ft by responding affirmatively to the question below. In addition, anniverseries of birth dates, when known, are identified in our quarterly newsletter.

Home Phone: ____________________   Work Phone:_____________________

Publish home phone number in the MCCA Directory? Yes___ No____

Date of Birth:______________________                  Place of Birth: ___________________________

Nickname or Name by which you are called/known:________________________________________
Current Occupation:_________________________________________________________
Where Employed:____________________________________________________________

Marital Status

(Check One): Married___ Single___ Widowed___ Separated__ Divorced___

Spouse's Full Name:______________________________________________________

Date of Marriage:________________________      Name by which spouse is called______________

Publish spouse's name in the MCCA Directory? Yes___ No___

Number of Children: _____ Number of Grandchildren: ____

Educational Status

Some High School___ Completed High School/GED___ Some College___

College Graduate___  Degree/Major___________ College/University_______________

Doctorate___ Major___________________ University_________________________