Modify Veteran's Information

Modify a Soldier

1st Battalion 12th Infantry Regiment Roster

Please fill in the required information marked with a (*) to identify the veteran to be modified.

NOTE: We haveve been having some difficulty with this form failing when submitting. If you get an error message, please email the information to Del Willenbecher at <thewillgroup@aol.com>

SOLDIER INFORMATION

*Last Name:	*First Name:	Middle Initial::

Nickname:	Suffix (i.e., Jr.)

Fill in any information that you would like modified to the roster.

If you do not fill in a field it will not appear on the roster.

Use the tab button to move through the form.

Press the "Enter Key" or press the "Submit" button to submit the form.

DO NOT PRESS THE ENTER KEY UNLESS YOU WANT TO SUBMIT!!

Company:	Platoon:	Squad:	Rank:

MOS:

Date arrived: (MM/DD/YYYY)*	Date departed: (MM/DD/YYYY)*

*(While we prefer the exact dates, years will suffice.)

Enter the following information if the veteran is deceased.

Date of Expire: (MM/DD/YYYY)

Submitted by:

First Name:	Last Name:

Relationship to veteran:

(i.e., Self, mother, father, sister, friend from unit, etc.

The following information will not be made available on the Internet website. It will be used to notify veterans of reunions or to put buddies in touch with each other.

Address:

(i.e., 909 Edmonds Road)

(i.e., Apt/Suite)

City:	State:	Zip Code:

Veteran's Email 1:

(i.e., Anyname@msn.com)

Veteran's Email 2:

(i.e., Anyname@msn.com)

Home Phone Number:

(i.e., 215-123-4567)

Alternative Phone Number:

(i.e., 215-123-4567)

More Information:

If you have additional information or comments please add them to the following box.

This information will not be immediately reflected on the website's roster. It is manually reviewed and added by volunteers. Therefore, please allow a period of up to six weeks for your information to be posted to the website. We thank you for your cooperation.

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