*
Required Entries - If not filled in, you will get an error message
Name:
*
,
(Last)
(First)
(Middle, or initial)
ID Card Expiration Date or your 65th birthday:
*
(YYYY)
(MMM)
(DD)
Address:
*
(Number and Street)
(Additional
Address)
City:
*
State:
*
Zip:
*
Telehone:
*
(Include
Area Code)
E-Mail:
*
To send by Email, you must enter your email address. If Printing
& Mailing, it can be blank
Alternate Contact:
,
(Last)
(First)
(Middle, or initial)
Relationship:
Address:
(Number and Street)
(Additional
Address)
City:
State:
Zip:
Telehone:
(Include
Area Code)
E-Mail:
Please
notify me of my ID card expiration by: Telephone
Either
click on Submit
below to send this as an Email or Print
this page and mail to: Military
ID Card Notification Program, HRCMOAA, P.O. Box 4612, Virginia Beach, VA
23454-0612
Signature
__________________________________
If submitting by Email,
type your
initials in the box
to "sign" this form
