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Name (if applicable) Mailing Address: (if different from above) Email Spouse's Contact Info Home Phone Cell Phone Work Phone Name Rank/Rate ( ) Work phone # Projected Rotation Date ( ( ( ) ) ) Age Date of Birth Children's Info Primary Emergency Name Point of Contact Secondary Emergency Name Point of Contact Anyone Else you would Name like command information and newsletters to be sent to (e.g. parents) Name Phone Email Phone Mailing Address Email Mailing Address Email I authorize .

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