PLEASE FILL IN QUESTIONNAIRE

Return completed form to:

Jim Tabor

17219 Seven Springs Way

Riverside, CA 92604

Annual dues are $20.00 and run from reunion to reunion. Please make check payable to:

U.S.S. Mansfield DD-728 Association

PLEASE PRINT ALL INFORMATION

NAME: ________________________________________________________________

ADDRESS: _____________________________________________________________

CITY: _________________________________ STATE: _______ ZIP+4: ___________

TELEPHONE: ___________________________________________________________

SPOUSE’S NAME: _______________________________________________________

RETIRED NAVY? YES [ ] NO [ ]

SERVED ABOARD THE MANSFIELD FROM: ______________ TO: _____________

RATE/RANK WHILE ABOARD: ___________________________________________

RATE/RANK UPON DISCHARGE: _________________________________________

ABOARD MANSFIELD COMMENTS/OBSERVATIONS