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(Indicate if officer or member, past or present, of any professional, scientific, political, civic or social organization.)
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Military or Naval Record; or National Defense Work __________________
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Clubs _______________________________________________________________
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Hobbies _____________________________________________________________
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Author (List all books and important monographs and give date of publication.)
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Submitted by ________________________________________________________

PLEASE CHECK: 
Will send photograph □; 
Will not sent photograph □.


Transcription Notes:
---------- Reopened for Editing 2024-02-09 15:22:56 ---------- Reopened for Editing 2024-02-11 16:05:42