1.  Did you know that there is a Commission especially for woman veterans?  Yes No
    If yes, where did you hear about it?

2.  In what branch(s) of the military have you served? 

3.  What were your dates of service? 

4.  Do you have any dependents?   Yes No

5.  Do you know about (or) would like to take advantage of the benefits that are available to you and your dependents if you so qualify?   Yes No

6.  What is the best mode(s) of communication for you when trying to keep updated with current veterans information?  (check all that apply)

call Bureau of Maine Veterans Services (BVS) at 1-800-345-0116
radio/television
newspaper/newsletters
internet (BVS's web site)
local veteran organizations (i.e. VFW)

7.  Would it be helpful to receive a newsletter pertaining to current women veterans issues? Yes No   If yes, how often?  Once per month Six per year Three per year

8.  Would you be interested in participating in an Oral History Project regarding your active duty experience?  The project would serve as a link to exploring the many wonderful contributions of women veterans.  Yes No

9.  Do you know of any immediate concerns the Commission should address?

10.  Please complete your name, address, phone number and e-mail address:

Name: Tel: E-mail:
Street Address:
City/Town: State: Zip: