Print out this page and send to the address below.        
               
               
  Membership Application / Database Update Form       
               
If you served with 1Tp 4th/19th PWLH, 1APC Troop or Squadron and A or B Sqns of the 3rd Cavalry Regiment in Viet Nam on posted strength, detached or just on a visit to the units mention, you are  
welcome too join the 3rd Cavalry Regiment Viet Nam Association, or just register your information for the database. Annual Membership Due ($20.00) 25th April each year. Send Cheque/Money Order made payable to: 3rd Cavalry Regiment (Vietnam) Association  Inc, and address to:  
         
                   
Dallas Burrage        
61 Sawtell Road,        
TOORMINA, 2452        
NSW            
               
Surname: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      
Given Names: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     
Name known by or Nickname: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .          
Street Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      
Suburb/Town: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        
State: . . . . . . . . . . . . .                 
Country: . . . . . . . . . . . . . . . . . . . . . . . . . .        
Postcode: . . . . . . . . . . . . . . . . . . .         
Contact Phone Numbers: Home / Work / Mobile: . . . . . . . . . . /  . . . . . . . . . . / . . . . . . . . . .  
Occupation/Retired: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .           
Current/Former Regimental Number: . . . . . . . . . . . . . . . . . . . .       
Year/s service in Vietnam: . . . . . . . . . . . . . . . . . . . . . . . . . . .        
Squadron/s: . . . . . . . . . . . . . . . . .        
Troop/s: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .       
Section/Call Sign: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      
Wife/Partner's Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        
Email address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Webpage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .