Enrollment and Information Form

Name: __________________________________________________

Address: ________________________________________________

City: ________________________ State: _______ZIP: ___________

Phone: ______________________

E-Mail: __________________________________________________

Spouse: _________________

Served with the 12^th Cav:  WWII_____  Korea_____ Vietnam_____

 Germany _____ Bosnia_____   Iraq_____ Other_____

12^th Cav Units Served With: __________________________________

Dates Served in 12^th Cav:  From_______ to ________

Short Biography of Military Service: ____________________________

  ________________________________________________________

Personal Biography: ________________________________________

  ________________________________________________________

Dues are $10 per year (normally paid from July 1 through June 30^th)

If including dues, please show amount here: ____________

Please return to:           Trooper Roger C. King, Treasurer

                                      12^th Cavalry Regiment Association 

                                      885 SW 6^th Street

                                      Lincoln City, OR 97367-2709

(541) 996-4181