E-Mail:
First Name: M.I.: Last Name:
Address:
City:
State:
Zip/Postal:
Phone:
Date of Birth (yyyy-mm-dd):
Highest Rank/Rate/Position Achieved:
Military Service/Federal Civilian Service Inclusive Dates (yyyy-mm-dd): From To
Branch of Service:
Other Service (Please Describe):
Highest Civilian Position Achieved:
Academy, University, College, Degree(s), Technical School(s):
Aircraft Flown (8 Maximum):
Pilot or Aircrew Designation (Mil & Civ):
Combat Exp (Theaters, Campaigns):
Notable Assignments (Limit of five):
Asociation and service organization memberships (Limit of five):
Highest personal decoration or award (Limit of one):
Significant achievements (flight time, commands, professional milestones, community involvement, etc.
Submitting as an "In Memorium" entry
I further understand that I may submit a photograph for inclusion.
Photo may be e-mailed as an attachment to:
(browngib@cableone.net)
I wish to become a member/upgrade my membership in Coast Guard Aviation Association (The Ancient Order of Pterodactyl). This link will take you to the membership registration page. (Come back here after submission of this Log entry by using the Browser Back Button.
Information