GW Vets of Long Island, New York

Name: Address: Phone: Please check one of the following: Vet ___ Spouse ___ Family Member ___ Interested Party ___ Branch of Service: MOS: Unit you where with: Where you given shots but not deployed: Location in the Gulf: List the medications recieved in the Gulf ( Pills, shots): Are you showing any symtoms of GWS? If so, please describe in your own words what they are:

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