EMERGENCY NOTIFICATION DATA
PERSONAL INFORMATION
LAST NAME	FIRST NAME	MI

CAP RANK

CAPID

ADDRESS

CITY

STATE AND ZIP CODE

CIVIL AIR PATROL UNIT INFORMATION
UNIT CHARTER NO.

NER-NY-117	UNIT NAME

COL. FRANCIS S. GABRESKI SQ.	UNIT LOCATION (City and State)

PATCHOGUE NY
UNIT COMMANDER’S NAME

LOUIS P. FENECH, JR.	CAP RANK

MAJ	TELEPHONE (Weekdays)

AC: 631	NO. 563-3440
ADDRESS

100 BARTON AVENUE PATCHOGUE, NY 11772	TELEPHONE (Nights & Weekends)

AC: 631	NO. 567-7191
PERSON TO NOTIFY IN CASE OF EMERGENCY
NAME (Mr., Mrs., etc.)

RELATIONSHIP

TELEPHONE (Weekdays)

AC:	NO.
ADDRESS

TELEPHONE (Nights & Weekends)

AC:	NO.	CELL PHONE

CAP FORM 60, DEC 03	Previous editions will not be used after 31 Mar 04	OPR/ROUTING: LMM

EMERGENCY NOTIFICATION DATA
PERSONAL INFORMATION
LAST NAME	FIRST NAME	MI

CAP RANK

CAPID

ADDRESS

CITY

STATE AND ZIP CODE

CIVIL AIR PATROL UNIT INFORMATION
UNIT CHARTER NO.

NER-NY-117	UNIT NAME

COL. FRANCIS S. GABRESKI SQ.	UNIT LOCATION (City and State)

PATCHOGUE NY
UNIT COMMANDER’S NAME

LOUIS P. FENECH, JR.	CAP RANK

MAJ	TELEPHONE (Weekdays)

AC: 631	NO. 563-3440
ADDRESS

40 LANGUTH STREET, SAYVILLE, NY 11782	TELEPHONE (Nights & Weekends)

AC: 631	NO. 567-7191
PERSON TO NOTIFY IN CASE OF EMERGENCY
NAME (Mr., Mrs., etc.)

RELATIONSHIP

TELEPHONE (Weekdays)

AC:	NO.
ADDRESS

TELEPHONE (Nights & Weekends)

AC:	NO.	CELL PHONE

CAP FORM 60, DEC 03	Previous editions will not be used after 31 Mar 04	OPR/ROUTING: LMM

EMERGENCY MEDICAL DATA

PERSONAL PHYSICIAN	PHONE

PHYSICIAN'S ADDRESS	CITY

BLOOD TYPE

PERTINENT MEDICAL DATA (Allergies, Diseases, Chronic Illnesses, medications, etc.)

CAP FORM 60, DEC 03	REVERSE

EMERGENCY MEDICAL DATA

PERSONAL PHYSICIAN	PHONE

PHYSICIAN'S ADDRESS	CITY

BLOOD TYPE

PERTINENT MEDICAL DATA (Allergies, Diseases, Chronic Illnesses, medications, etc.)

CAP FORM 60, DEC 03	REVERSE

Cut here

EMERGENCY NOTIFICATION DATA

jsanderson

2006-03-09

Louis P. Fenech, Jr.

J. Sanderson

Civil Air Patrol, Inc.