THE REGISTRY

SUBSCRIBE FOR THE LATEST NEWS

JOIN NOW

The Registry is a database managed by a non-government organization. Please feel free to voluntarily register below if you or a military family member are/were part of the Air Force ICBM missile community and have a diagnosed cancer, other disease, illness or disorder. We are collecting this information for the purpose of supporting, informing, and/or supplementing current and future studies commissioned by proper authorities. Information in the Registry is stored with password protection and visible to site administrators only. View our privacy policy here. If you do not have a current diagnosis and want to stay informed, please click on the “Subscribe for the Latest News” link above.

Name

First Last

Email

Phone

Sex

Living or Deceased

Living

Deceased

Date of Death and Age (ex: 04/12/2012, Age 53)

ICBM Base(s) and Squadron(s) (ex: Ellsworth AFB, 44 OMMS; Malmstrom AFB 10 MS)

What Years Did You Serve? (ex: 1970-1975 Ellsworth, 1976-1981 Malmstrom)

Number of Alerts (Missileers Only)

Age at Diagnosis(es) (ex: age 48, age 50)

Year of Diagnosis(es) (ex: 2003 and 2005)

Diagnosis(es) (Please provide detail) (ex: hypothyroidism and thyroid cancer)(Required)

Stage/Type (If multiple diagnoses and one is "Cancer", select "Cancer")

Career Field

Permission to Disclose(Required)

Permission to Disclose Name and Illness to Congress or Investigating Agency

Yes

No

Anything else you would like to add?

2223

THE REGISTRY

JOIN NOW

Join Our Newsletter

Success!