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Office of Veterans Affairs

Office of the Governor

P. O. Box 2586

Pago Pago, AS 96799

684-633-4206 and 684-258-2585

 

Veterans Registration Form

 

Female

(optional)

 * State / Country

* Zip code:

Telephone

(enter at least one phone)

(or main phone)

(optional)

* Email

* Retype Email

Branch of Service

Rank

Date Enlisted

Date Discharged

Discharge Type

Disability

No

If Yes

%

Spouse

Spouse Phone

Dependents

No

How Many?

 

The information contained on this form will be treated as confidential and will be available only to authorized people.