Rep. John Siptroth
189th Legislative District
Monroe and Pike counties
Are you a Military Veteran?

As a veteran and a member of the House Veterans Affairs and Emergency Preparedness Committee, I am very interested in finding out more regarding the veterans living in the 189th Legislative District. If you are a military veteran, please complete the questionnaire

1) I served in the:
U.S. Army
U.S. Navy
U.S. Marine Corps
U.S. Air Force
U.S. Coast Guard
Pennsylvania Army Guard, Air Guard, or Reserves


2) I served in:
World War II
Korean War
Vietnam War
First Persian Gulf War
In either Operation Enduring Freedom or Operation Iraqi Freedom
I am a veteran who served in a time when there was no declared conflict


3) I am a 100 percent disabled, honorably discharged veteran:
Yes
No


Additional Comments:


First Name: * Last Name: *
Address 1: *
Address 2:
City * State: * Zip: *
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Cell Phone: