Please complete as many of the following fields as are applicable but some are obviously required. Please feel free to visit this form and resubmit at any time your information changes. With the passing of every year, there are fewer of us around. The personal information you submit will not be released to anyone not related to the 134th AHC.

A cellular number is requested because experience has shown that when individuals relocate Cell numbers are frequently retained; thus giving us a shot at contacting you should you forget to send us your renewal information.

If you're not sure whether we have your current data, submit the information. Better to have duplicating data than none! Once the form has been submitted you will receive an emai message within 24 hrs with a copy of your newly submitted data.

First & Middle Name

 (required)

Last Name

 (required)
Nickname (if any)
Spouse
Street or PO Box address (required)
City (required)
State
Zip Code (required)
Home Phone  
Cell Phone if your cell is your only phone, enter it in BOTH Home and Cell fields
Email Address (required)
Dates in the 134th AHC FROM: DEROS: (required)
Remarks (platoon, job, message, etc)
 

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Last modified: Friday October 11, 2019 .