Personal Data

First Name
Last Name	MI
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
E-mail
Web Page URL
Phone: Home
Phone: Work	Ext.   Fax

Date of Birth (mm/dd/yy)  

Occupation:

Service Branch USMC USN USA USAF CIA NSA Other Date Entered (mm/dd/yy): Date Discharged (mm/dd/yy):

Highest Rank   

Primary MOS and Description

Boot Camp or OCS Location 

Please list medals of merit you received

When did you arrive on, or become associated with LZ Russell?

Your Unit    

Previous Duty Station

Your main job associated with LZ Russell 

You Rank at this time.  Date left association with the LZ

Next duty station

Select any of the following options that apply:

FEB 25, 1969 I was on or associated with LZ Russell and the battle that took place there.    

I got a Purple Heart from this battle.           

I was Med-Evac'd off the hill.                 

I was permanently disabled from this battle.     

I was permanently disabled from another battle.  

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Email Address
Mailing Address
Phone Home
Phone Work
Birth Date

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