The Big Nickel Crewmember Registration
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Yellow : required 
Blue : optional, but recommended
This section contains your name and discharge or retirement date. If you are still active,
leave the discharge/retirement box empty and so indicate with the checkbox.
Your Name First: MI: Last: Suffix:
Discharge/Retirement Date:
Still On Active Duty:

This section contains your on board duty tour(s) information. Up to three tours may be entered.
If you served more than three tours on board, please contact the Webmaster with the additional information.
1st Tour 2nd Tour 3rd Tour
Tour Dates:
to to to
Rank/Rate: (i.e., Capt, LCDR, RD2, BM1, SN, etc.)
(Highest rank or rate during each tour)
Division(s) (i.e., B, E, 1st, OI)

This section is intended for the NATO Mixed Manning Demonstration crew. If you served onboard between
June 1964 and December 1965 or any portion thereof then you are considered part of the MMD.
If you were a member of the MMD crew and your name is not included in the Mixed Manning pages,
please notify the Webmaster and, if possible, include a photograph of yourself during your time on board.
NATO Mixed Manned Crew?
(Jun '64 to Dec '65)?
Yes: No:

The following information is kept in strict confidentiality. You may enter up to 2 email addresses.
Your Date of Birth:
Email address1:
Email address2 (optional):
Spouse/SO Name: First: MI: Last:
Spouse/SO Date of Birth:
Address 1:
Address 2:
State (if not US, enter country):
Zip/postal code:
Home phone:
Cell phone:

Your username/password will automatically register you for The Big Nickel Forums, allow you to modify
your information and allow you to contact other shipmates through the site.
Username (minimum 8 characters):
Password (minimum 6 characters):
Enter any comments you'd like to make about your time on board.
Currently there is a limit of 800 characters for your comments.

You have 800 characters remaining for your description...

I've just made a change to format your input phone number(s) to match that of your country.  I have yet to include specific formating for any other phone number format other than those for the United States.  I've done a little testing and found no problems, however, if you run into issues, please contact me with your information.