MAGGIE's Buddy Search Registration

SECTION A -- Personal Information

Please complete all these questions.

1. What is your mailing address?

   Last Name                     
   First Name & Middle Initial  
   Suffix (Jr., Sr., III, etc)if applicable)  or "Nickname"
   Street        
   City          
   State          Zip Code  + Four 
           

2. What are your other Points of Contact [Other than those noted in jump school]?

   E-mail     
   Area Code   Phone Number  

3. Did you retire from the Army? Yes No 

4. What was your highest/retired rank?  

5. What was your PMOS in SE Asia?  

6. What is your Social Security Number (Optional)? 

7. What is your Date of Birth (mm/dd/yyyy)? 

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SECTION B -- SE Asia Assignments

Please be as specific as you can, in providing the details of your Special Forces Assignments in South East Asia.

Table of Assignments

Detachment	From Date	To Date	Duties	Rank	Group	Remarks

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SECTION C -- Other information

1. Please check the statements for which your answer is "Yes."

   I have purchased the Green Beret magazine set
   I have sent copies of my orders pertaining to my SF assignments in SE ASIA.
   Please do not release my address/contact information.
   

2. Please enter any additional comments regarding our products or services:

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FORM SUBMISSION

Thank you for taking the time to answer the questions in our survey. Please review your input for accuracy.

This information will be compared to and posted to the database.

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