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Your RCEME ID number
First Name (required*)
Middle Name
Last Name (required*)
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Address
City
Province/State
Postal Code
Country
Home Phone
Work Phone
Fax Number
E-mail Address (please input if you have one)
Web Page Address (URL)
(MOC)
Trade
Retired from Service (Yes, No, Reservist)
Dates of Service (Years only- e.g. 1967-1994 or 1987-present)
Name of Spouse
Apprentice (Yes or NO)
Apprentice Platoon No.
Comments: Tell us a bit about yourself to help recognize you. Maximum 255 Characters
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