Title : ...........................................................................................................
Forenames : .................................................................................................
Surname : ....................................................................................................
Full postal address : .....................................................................................
Contact Phone / fax numbers : ......................................................................
Email address : ...........................................................................................
Homepage address if held : ..........................................................................
Date of Enlistment : .....................................................................................
Date of Discharge : ......................................................................................
Service Number............................................................................................
Highest Rank Held in the Military : .................................................................
NAVY - Detail to include ships names for each trip and dates for trips. ie - day,
month, year
AIR FORCE - Squadron and task numbers and dates for crews.
ARMY - We need dates and appointments held for each trip. Time at Deep
freeze Christchurch will not count
If you can supply names of other persons who were with you on the same trip then please list them so that we can add their names to our nominal roll
Any other information that you think relevant
Upon completion please forward this application along with $15NZ annual subscription to one of the following
Post application to
THE NEW ZEALAND ANTARCTIC VETERANS ASSOCIATION
Mike Smith
8 Price Tce
Matamata 3400
NEW ZEALAND
