Resources for the Veterans Community
California Women Veterans Roster - Roster Application Form
Mrs./Miss/Ms.: ____________________________________________________________
Service Name: ____________________________________________________________
Address: _________________________________________________________________
City: _____________________________________________________________________
County: __________________________________________________________________
ZIP Code: ______________________
Branch: ___________________________________
Rank/Rate: ________________________________
Service Dates: From: _______________________ to: _______________________
Veterans/military organizations (post or chapter number if applicable)
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Current Employer (if any): ____________________________________________________
Occupation/title: ____________________________________________________________
Work #: __________________________________
Home #: __________________________________
FAX #: ___________________________________
E-mail address: _____________________________________________________________
______ Please check here if you would like your name, rank, branch of service and dates of service
included in the California Veterans Memorial Registry.
When completed, please send to:
California Department of Veterans Affairs
California Women Veterans Roster
P.O. Box 942895
Sacramento, CA 94295-0001