Military Bases Claim Application Form


If you developed any type of cancer and you were stationed on one of these military bases for 1 year or longer you will qualify to receive a claim.
List any diseases that you currently have (including any type of cancer, Leukemia, Multiple Myeloma, Non-Hodgkin's Lymphoma, Non-Hodgkin's Lymphoma, Birth Defects, Reproductive disorders, Hodgkin’s Disease, End-stage renal disease, Parkinson’s disease, Liver Cirrhosis, Scleroderma, Eye defects, Impaired Immune System, Neurological effects, Neurobehavioral deficits, Hypersensitivity Disorder, Miscarriage, Cardiac defects, Choanal atresia, Major malformations, Neural tube defects, Oral cleft defects, Small for gestational age, Fetal death, Low birth weight).

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