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Request for Defense Counsel
Request for Defense Counsel

Soldiers requesting for defense legal representation are asked to complete and submit the following form, which will be automatically emailed.

If successfully submitted, you will receive a confirmation from our defense team. Please complete the form as fully as possible.

Soldiers SHOULD NOT include any incriminating information on this form.

* denotes required fields
Last Name: *
First Name: *
Rank:
Branch/MOS:
Years of Creditable Service:
Expiration Term of Service Date:
Unit:
Home Address:
Address (Cont'd):
City:
State:
Zip Code:
Work Phone:
Cell Phone:
Email: *
Status: AGR   M-Day   Tech   Other
   
If known, please provide your Readiness NCO contact information
Name:
Rank:
Phone Number:
Email Address:
   
If known, please provide your Commanderís contact information
Name:
Rank:
Email Address:
   
To Help Prevent Spam, Please Enter Any TWO Digits (Ex. 37): *
   
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