ENROLLMENT & UPDATE FORM:
VIETNAM VETERANS of BRAVO BATTERY
1stBn 12th MARINE Regiment (April 1965-October 1969)
Please copy this page & send with optional $10.00 Dues Check Payable to:
Ellen Jean Bradley
11657 Kipling Drive
Waldorf MD 20601-2901
NAME:
ADDRESS (so we can mail your I.D. Card):
PHONE Number:
E-MAIL:
D.O.B.:
DATES w/ Bravo
GUN:
SECTION: (FDC, COMM, MT, ETC)
If FORWARD OBSERVER: Company assigned to:
HONORS (Silver/Bronze Stars, Purple Heart, etc. and Operation(s) where awarded if known)
SPOUSE:
COMMENTS:
