HMR/L HMM-363 Member Contact Info Form 

  If you have more than one residence i.e. Summer/Winter please fill out two forms

Please fill in all fields marked with a *

Last Name *
First Name *
MI or Middle Name *
Mailing Address
PO Box or Street		 *
City *
State *
Zip Code *
Home Phone *
Mobile Phone
eMail Address *
Spouse Significant Other *
Rank in HMM 363
Time in HMM 363 ie 1954 to 1956
MOS
Nickname
Comments