This form is for Veteran info ONLY Try to complete as much of the form as you can For now it will take about four days before this will show up on the roster

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Date of service onboard: 

Which ship?    CA-39   CA-71         Service:   Navy    Marine

City lived in THEN:     State lived in THEN: 

First:   Middle:   Last: 

Nick Name:   Spouse Name: 

Address: 

City:   State:  Zip: 

Phone:     Email: 

Rank onboard:   MOS: 


Other duties onboard: (400 characters or less).



Comments: (400 characters or less).

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  Please check here if this person or their Spouse are deceased:
Person above    Spouse

Person filling out this form: 

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