Purple Hearts

Hill 4-11 Purple Hearts Database Registration/Update Form

If you choose not to create a User Id and password for the Hill 4-11 Purple Hearts Database to enter your information, you can enter your information in the following Hill 4-11 Purple Hearts Database Registration/Update Form, and the webmaster for this web site will enter your information into the Hill 4-11 Purple Hearts Database for you.

You can also use this form to register or update the Purple Heart information for someone else who served with the 3rd Battalion, 1st Infantry or one of its supporting units during the Vietnam War. (Delta Battery, 6th Battalion, 11th Artillery; 26th Engineer Battalion; E Troop, 1st Cavalry; 174th Assault Helicopter Company; 59th Infantry Platoon Scout Dog; 523rd Signal Battalion, etc.)

Please use the following form to input a new submital or update to the Hill 4-11 Purple Hearts Database:

Is this a self-registration? Yes No (Required)

If this is an update to an existing Purple Hearts entry, enter only the information that needs to be updated. Otherwise, enter as much information as possible.
Last Name:	(Required)
First Name:	(Required)
Middle Name:
Rank:
Primary Assignment:
Vietnam Unit:	(Select the lowest level unit in this list)
Company:
Platoon:
Purple Heart Number:
Date of Event:	(Required)
Casualty Location:	Brief Description of Where the Casualty Occurred
Event Description:	Brief Description of What Happened During the Event
Outcome:	Brief Description of What Happened After the Event
Comments:
Your Name:	(Required)
Your Email Address:	(Required)