Name: ____________________________________________________________________________

Address: __________________________________________________________________________

Phone Number: _____________________________________________________________________

Email Address: _____________________________________________________________________

Father's Name/Name of Loved One: ____________________________________________________

Branch of Service: ____________________________                     Rank: _____________________

KIA/MIA/DOD Date: _____________________    Panel/Line No: _____________________________

Your relationship to this person: _______________________________________________________

Have you attended any of the previous Father's Day Reunions?: _____________________________

If a son or daughter, may we have your mother's name?: ___________________________________

Do you have siblings who may be interested in SDIT?: _____________________________________

Do you have any children?: ___________________________________________________________

Are you interested in speaking, in your area, on behalf of SDIT?: _____________________________

Are you interested in being a contact person for the new members in your area?: _______________

Are you currently an SDIT chapter member?: ______ If so, which chapter?: ____________________

Are you a member of any Veteran's organization?: ________ If Yes, which one?: _______________

Please Send to:

Sons & Daughters In Touch
DATABASE
c/o Jim Sampers
845 S. Everett St.
Lakewood, CO  80226