| First Name |
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| Last Name |
Enter your last (or maiden) name
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| Married Name |
Enter current last name if different
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| Nickname |
Did you have a nickname?
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| Address |
This information will not be shown publicly. If we need to contact you we will access this info. Nothing will be sent to you from third parties.
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| City |
Enter the city where you live.
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| State |
Enter the state where you live
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| Country |
Enter the country code of your current address
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| Zip Code |
Enter your Zip Code (postal code)
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| Phone Area Code |
3-digit Area Code
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| Phone |
Your primary contact number (numbers only without - ) See example
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| Email |
Enter your email address (check carefully)
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| Email Verify |
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| Email2 |
Do you have a backup email, in case your main email fails?
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| Mailing List |
do you want to receive our newsletter and occasional email announcements?
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| School or Base Names |
Enter one or more school or base names. Check spelling carefully!
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| Birthdate |
Enter your birthdate. (optional but highly recommended)
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| Graduation Year |
This establishes the year you graduated from high school, but not which school
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| Referer |
How did you hear about the Military Brats Registry
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| Passwd |
Enter a unique password
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| Captcha |
7 × 3 = ?
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