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  PRD-1 BL                                                               ANK Patch
ASA WORLDWIDE
DATABASE INPUT FORM
Maintained by Vern Greunke  - (05D)
Register yourself in the ASA Database & I will eMail you
the URL & Password for the ASA On-Line Database
If You Are ALREADY REGISTERED... CLICK HERE


NOTICE!!!!
THIS FORM HAS NOT GENERATED THE PROPER EMAIL TO ME SINCE FRIDAY, OCT. 1ST.
IF YOU FILLED IT OUT SINCE THEN PLEASE SEND THIS SAME INFO BY PRIVATE EMAIL
TO ME AT: vgreunke@alltel.net
WHEN THIS NOTICE IS GONE .... EVERYTHING WILL BE WORKING AGAIN! (HOPEFULLY!!!)
THANKS FOR YOUR HELP .... - Vern the Webmaster



Any information you DO NOT WANT RELEASED type "N/A" in its place)
Name:  
Address:  
City:  
State:    Zip Code  
Phone Number - Use Format: 555-000-9999  
ASA MOS:      
Duty Station #1:      Year Arrived At #1:  
Duty Station #2:      Year Arrived At #2:  
Duty Station #3:      Year Arrived At #3:  
Enter Your VALID e-Mail Address:   
(note: I USUALLY respond and acknowlege ALL input data within 24 hours.
If you receive NO response from me  please re-enter your data or contact me directly.
You will receive the password scheme data at that time.   Thanks!   - Vern