Agent Orange Tower Registration Form
Name:
EMail:
ID :
Q 1 : Are you planning to build an Agent Orange Tower?
Yes,if we can get the material and land donated
Not sure, need more info
No, just seeking information
Yes, have site and materials ready
Still undecided
Q 2 : Are you affiliated with a veteran or other organization? If so, please give name/location and chapter/branch.
Q 3 : When do you plan to build this tower?
Q 4 : Do you have the blueprints?
Yes, saved from this site
Received via mail
Received from other source
No, I need the blueprints.
Q 5 : Do you have property available?
Yes
No
Unknown
Trying to have some donated
Q 6 : Is this property (check all that apply)
on a major highway
on a secondary road
in an urban area
in a sparsely populated area
other
Q 7 : Where do you plan to build this tower?
Q 8 : Do you need technical assistance or wish us to contact you?
Yes
No
Q 9 : Please list your name, address and phone number, including area code, in the box below. Also the best time to contact you.
Q 10 : Have you registered this info previously?
Yes, this is another tower
Yes, but previously registered tower was not built
No, this is our first registration
Unknown
