Member #: (If unknown, leave blank)

Name on Record to be Corrected: (required)

(Rank/Salutation, First, Middle, Last)             (Maiden)

Current Address:

Previous Address:

Home Phone: Work Phone:

E-Mail:

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Name of Person Requesting Correction: (required)

Address of Person Requesting Correction: (required)

Home Phone: Work Phone:

E-Mail of Person Requesting Correction: (required)

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(Please check appropriate boxes for changes)

Name: Change Addition
Select Name Type Married Name Maiden Name Previous Married Name Middle Name Nickname AKA (Also Known As) Service Name Other

Change Addition
Select Name Type Married Name Maiden Name Previous Married Name Middle Name Nickname AKA (Also Known As) Service Name Other

Change Addition
Select Name Type Married Name Maiden Name Previous Married Name Middle Name Nickname AKA (Also Known As) Service Name Other

Change Addition
Select Name Type Married Name Maiden Name Previous Married Name Middle Name Nickname AKA (Also Known As) Service Name Other

Date of Birth: Change Addition Other

Date of Death: Change Addition Other

Birth Place (City/State): Change Addition Other

Hometown (City/State): Change Addition Other

Service: Change Addition Other

Service Dates: Change Addition Other

Highest Rank: Change Addition Other

Decorations: Change Addition Other

Memorable Experience: Change Addition Other

Other: Comments Change Addition Other

Photograph:

For photo updates, changes and/or additions to be sent via e-mail, photo specifications are:
Picture width - 713 pixels
Picture height - 969 pixels
Color Depth - 24 bit color
Resolution - 300 dpi
Save as a JPEG file using JPEG Baseline Standard with Quality of 8, then e-mail it to regdept@womensmemorial.org or mail your picture to:
Women's Memorial
Attn: Registration Department
Dept 560
Washington, DC 20042-0560