Enewetak Atoll Atomic Cleanup Veterans Membership Roster
First Name *
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Middle Name
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Last Name *
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Nickname
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Employer at Enewetak *
TDY Unit Assigned at Enewetak Atoll
(ex: C Company, 84th Engineer Battalion)
Your answer
Rank
(E-00 W-00 O-00)
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Job Title
(5 character Military Occupational Specialty Code and Title)
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Tour #1 Began
Known or Estimated Dates
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DD
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YYYY
Tour #1 Ended
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/
DD
/
YYYY
Tour #2 Began
MM
/
DD
/
YYYY
Tour #2 Ended
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/
DD
/
YYYY
Island Lived at Enewetak Atoll
Description of Work Performed at Enewetak Atoll
Your answer
Islands worked at Enewetak Atoll
Your answer
Do you have any health challenges which may be related to radiation exposure?
Comments about your health challenges.
Your answer
Veterans Administration Health Assistance?
Comments about your experiences with the Veterans Administration.
Your answer
Which Social Networks do you have accounts?
Where can YOU be found on the Internet?
Copy and paste the URL from YOUR: Public Website, Personal Blog, Business Website, or Main Social Network Profile Page.
Your answer
Current Residence
City and State
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Email Address *
Your email will not be published nor shared.
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I hereby give the owner(s) and assigns of AtomicCleanupVets.com the right to publish my personal photos, documents, opinions and comments about the events connected to the Enewetak Atoll Atomic Debris Cleanup Mission for historical and promotional purposes. *
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