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First Name:
Last Name:
Year of Birth:
Email:
Phone:
Home State:
AE
Alabama
Alaska
AO
AP
Arizona
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California
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Connecticut
Delaware
District of Columbia
Florida
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Hawaii
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Maine
Maryland
Massachusetts
Michigan
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Mississippi
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Montana
N/A - Foreign Addresses
Nebraska
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New York
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Ohio
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Rhode Island
Saipan
South Carolina
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Tennessee
Texas
Utah
Vermont
Virginia
Washington
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Wisconsin
Wyoming
Home Zip Code:
Prior Cadet:
Yes
No
Last Cadet Rank:
- Select Prior Cadet Rank -
E1/SR
E2/SA
E3/SN
E4/PO3
E5/PO2
E6/PO1
E7/CPO
Prior Adult Volunteer:
Yes
No
Last Adult Volunteer Rank:
- Select Prior Adult Rank -
MIDN
INST
WO
ENS
LTJG
LT
LCDR
Military Affiliation:
(click if affiliated)
Military Branch:
- Select Military Branch -
U.S. Marine Corps
U.S. Army
U.S. Navy
U.S. Air Force
U.S. Coast Guard
U.S. Space Force
Military Status:
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Active
Reserve
Inactive Reserve
Retired
Veteran
Military Pay Grade:
- Select Military Pay Grade -
O-10
O-9
O-8
O-7
O-6
O-5
O-4
O-3
O-2
O-1
W-5
W-4
W-3
W-2
W-1
E-9
E-8
E-7
E-6
E-5
E-4
E-3
E-2
E-1
Years of Service:
- Select Years of Service -
1 years
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
11 years
12 years
13 years
14 years
15 years
16 years
17 years
18 years
19 years
20 years
21 years
22 years
23 years
24 years
25 years
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27 years
28 years
29 years
30 years
31 years
32 years
33 years
34 years
35 years
36 years
37 years
38 years
39 years
40 years
What unit/s were you a member of:
