Page 20 - Delaware Medical Journal - January 2017

MOST SIGNIFICANT DUTY ASSIGNMENT:
WOUNDS RECEIVED AS A RESULT OF ACTION WITH ENEMY FORCES:
LIST DECORATIONS, MEDALS, BADGES, COMMENDATIONS, CITATIONS, SERVICE RIBBONS, AND CAMPAIGN STARS AUTHORIZED:
LIST SIGNIFICANT SERVICE SCHOOLS OR TRAINING COURSES:
DATES OF FOREIGN (OVERSEAS) SERVICE:
PLACE OF FOREIGN (OVERSEAS) SERVICE:
THEATER AND OTHER LOCATIONS OF OVERSEAS SERVICE:
SECURITY CLEARANCES GRANTED:
DATE OF SEPARATION FROM SERVICE: PLACE OF SEPARATION: DESCRIBE YOUR MOST SIGNIFICANT EVENT OF MILITARY SERVICE:
ADDITIONAL REMARKS:
Thank you for providing your information. Please be sure to include copies of documentation and photographs to enhance the story of your service in the military.
To ensure we are capturing as many Delaware physicians having military service, please provide information of those who served in any service, rank, or branch, whether or not they continue to practice in Delaware, are retired, located out of the area, or are deceased.
NAME:
DATES OF SERVICE:
ADDITIONAL REMARKS/CONTACT INFORMATION:
NAME:
DATES OF SERVICE:
ADDITIONAL REMARKS/CONTACT INFORMATION:
SERVICE: AWARDS, ETC.:
SERVICE: AWARDS, ETC.:
Thank you for your time and information in helping the MSD Historical Committee preserve the military history of Delaware physicians. Information collected will be archived at the Medical Society of Delaware.
Please return completed forms and copies of documentation to:
Medical Society of Delaware FAX: (302) 366-1354 Contemporary Veteran Project PHONE: (302) 366-1400 900 Prides Crossing
Newark, DE 19713
20 Del Med J | January 2017 | Vol. 89 | No. 1