UAV Registration Form

UKRAINIAN AMERICAN MEN AND WOMEN IN THE USA MILITARY SERVICE UAV REGISTRATION P.O. BOX 172 Holmdel, New Jersey 07733 e-mail: uav.reg@worldnet.att.net COMPUTER REGISTRATION DATA For Ukrainian American veterans and active duty, Reserve, Guard, and Public Health living or deceased PLEASE PRINT OR TYPE ALL INFORMATION. Last Name:___________________________First Name:__________________________ (_______________________) put maiden name in parenthesis Address:____________________________________________________ID#_______________________ City:____________________________________State:___________ZIP:_______________________ Daytime phone: (_____)_________________________evening (____)_________________________ fax: (_____)_____________________________e-mail:___________________________________ Birthday: ____/____/_____ Place of Birth________________________If Deceased ____/____/____ ---------------month day year------------------------------------------------------------------------------month day year When did you and/or your ancestors arrive to the USA?_____________________________ From which country?_______________________________ When did you and/or your ancestors become USA citizens? [___]myself[___]ancestor __________(indicate year) Your Ukrainian ancestry is on your [___] mother's side [___] father's side [___] both Your mother's maiden name:________________________________________ Are you UAV member?______if yes, Post No._________US Veterans Post specify)________________ Branch: (circle) USA USN USMC USAF USCG USMM USNG USPHS Reserve SERVICE DATES - including active duty, Reserve, and National Guard (attach copy of Fm DD214) From:___________________________ to ________________________ From:___________________________ to ________________________ From:___________________________ to ________________________ Reserve Military Decorations:___________________________________________________________________ Highest Rank or Grade:___________________________If deceased, place of burial ________________ Other:______________________________________________________ [__] Retired from military service [ ] Nurse Corps [__] Photo taken in uniform enclosed, if available - no photocopier prints, please. If registered by other than above, please indicate relationship to the veteran being registered: ___________ If you have memorable military experiences, please write on the back of this page. Your short autobiography will be appreciated. date_______________ Signature:______________________________________________ Please return entire form with a copy of form DD214 and photo to the above address. Thank you. You do not have to be a member of the Ukrainian American Veterans to register..