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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
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District of Columbia
Florida
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Hawaii
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Maryland
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N/A - Foreign Addresses
Nebraska
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Texas
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Vermont
Virginia
Washington
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Wisconsin
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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
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14 years
15 years
16 years
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22 years
23 years
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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: