58th Membership Roster
First Name:
Last Name:
Name of person if other than
Veteran completing this form:
Current address/street:
City:
State:
AL
AK
AR
AZ
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
VI
UT
VT
VA
WA
WV
WI
WY
Zip:
E-Mail (optional):
Family Information (start with your Parents and include the names and relationships that you feel are appropriate):
Hometown when you entered the
Service:
Service Number:
Date you entered the Service:
Service Schools attended:
Month/Year
Month/Year
Month/Year
Military Specialty Earned/Assigned:
1)
2)
Military Rank Upon Discharge:
Bomb Group:
40th:
444th:
462nd :
468th:
Other:
Squadron:
25th:
676th:
768th:
792nd:
Other:
44th:
677th:
769th:
793rd:
Other:
45th:
678th:
770th:
794th:
Other:
395th:
679th:
761st:
795th:
Other:
Location of Unit when assigned:
Date:
Awards/Decorations received:
Missions Flown (if applicable):
Hump Missions Flown (if applicable):
Targets:
Ground Crew:
Yes
No
Flight Crew:
Yes
No
If "Yes" to either of the above:
Aircraft Serial Number/s:
Aircraft Name/s:
Were you a POW?:
Yes
No
Where?:
Were you interned?:
Yes
No
Where?:
Date transferred from the
58th Bomb Wing:
Date Discharged:
Post-World war II Military Service:
Post-World war II Civilian Occupation/s:
Your thoughts about what your service in the 58th Bomb Wing during World War II means to you:
Further Comments :