Name:_______________________________________
Street:_______________________________________
City:_______________________ State:________ Zip:____________
Phone:___________________ E-mail Address:___________________
Vietnam Unit: ___________________ Dates of Vietnam Service:___________________
Hill 4-11 Association Dues | $25.00 |
Scholarship Fund Contribution | $_____ |
____ Copies of Hill 4-11 History 2nd Edition @ $17.50 each | $_____ |
Total | $_____ |
Hill 4-11 Association
ATTN: Dick Hill, Treasurer
630 Woodside Dr.
Kent, OH 44240-2664