1.  Name: 

2.  Address: 

3.  Phone: 

4.  E-mail: 

If you are a family member and were never employed while you lived in Southeast Asia, please skip to question 11 and submit the form.  If you were employed by CAT or Air America or anyone else while you lived in Southeast Asia, please fill out the following questions as they pertain to your experiences.  Thank you. 

5.  With whom did you work in Southeast Asia?  (CAT, Air America, US military, other - please list all).  

6.  Years of service with those organizations:

7.  Jobs and positions held (if pilot, please list aircraft flown in Southeast Asia):

8.  Units and locations of assignment during the Wars in Southeast Asia (please include dates, places and positions held):

9.  Major programs, events, and engagements in which you were involved (please indicate unit/organization of assignment/employment):

10.  If military, what was your rank at discharge/retirement or what is your current status: 

11.  With whom was your relative employed and what is your relation to him or her?