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The President’s Message Lt Col Brett Fehrle (NGB) Hi Fellow MSC's, I hope to see all of you at Readiness Frontiers (RF) in Minneapolis, MN in June. We have a lot of great courses for all career tracks, Admin, Logistics and Readiness to get "Back to the Basics" for all MSC's. For the first time ever at RF we are offering our Readiness Verification Skills (RSV) for the MSC's instead of FEMA training. We have heard the call from everyone at past RF to offer them and now we are meet- ing the call. We have some really good speakers from all tracks coming to brief to give the latest status of different programs so we can get the word out. I don't think we should move away from the FEMA courses but this year we wanted to meet the call. I recently attended an IMT Operations Chief Course promoted by Health and Human Services and it was an outstanding course, in the future we may have the opportunity to add this to our planners track so we as the ANG can work very well with our civilian counterparts in the time of a crisis. I have been in my new job at the Readiness Center for a short while now and I have a totally new per- spective on how much work has to be accomplished at this level. I invite all of you at some point in your career to take an MPA tour or a stat tour position here at NGB. It will help you in your career growth in all of the MSC tracks, Logistics, Admin, and especially the Readiness portion. I know as a traditional guardsmen it is hard sometimes to step out of our civilian jobs to take on new responsibilities and roles that come available in the ANG, but we can't always say to ourselves, someone else can do that job. If you have a skill set or want to grow a new one, love your Guard job, and your civilian job supports USERRA as it should, take a small MPA tour or Stat tour to help the Guard and grow your MSC skills to a new level. Remember if we don't maintain our skill sets to be Ready, Relevant, and Reliable for the Air Force it doesn't help our Communities or the Air Force in time of emergencies. Thanks and remember "One Team, One Fight" Brett Fehrle, LtCol, USAF, MSC The MSC Minuteman AIR NATIONAL GUARD MEDICAL SERVICE CORPS Volume 3, Issue 1I May 1, 2010 If you are interested in becoming a member of the Society of Medical Service Corps Officers, a membership form has been provided on page 15. Mission: Improve and enhance healthcare administra- tion in the Air National Guard Unite and coordinate efforts of the Medical Service Corps Officers Elevate the practice of administration. CONTENTS: 1 —President;’s Column 2 BIO Col Worcester 4 Message from CFM 6 Senior MSC Spotlight 7 Article: AFMSA/SG Short Tour 8 Article: Atlanta CERFP 10 Current Finance Statement 11 Data Call-IMPORTANT Ques- tion from the Field!!!! 12 Membership Application TO CONTACT US President Lt Col Brett Fehrle [email protected], [email protected] ; 301-836-8563, cell 405-819-4436 Vice-President Lt Col Paul Loiselle [email protected] ; 603-430-2496 Treasurer Capt. Philip Plourde [email protected] ; Cell: 678-873-8954 Secretary Lt Col Susan Pangelinan [email protected] ; 707-290-3197 Membership Director Capt Christine Bringard [email protected]; [email protected] ; 801-245-2567; bb 406-899-6755 Information Director Lt Col Eterna G. Oehme [email protected] ; 278-7600 Com 301- 836-7600 Operations Director Maj Linda Dunegan [email protected], [email protected] ; 907-248-8961

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The President’s Message – Lt Col Brett Fehrle (NGB)

Hi Fellow MSC's, I hope to see all of you at Readiness Frontiers (RF) in Minneapolis, MN in June. We have a lot of great courses for all career tracks, Admin, Logistics and Readiness to get "Back to the Basics" for all MSC's. For the first time ever at RF we are offering our Readiness Verification Skills (RSV) for the MSC's instead of FEMA training. We have heard the call from everyone at past RF to offer them and now we are meet-ing the call. We have some really good speakers from all tracks coming to brief to give the latest status of different programs so we can get the word out. I don't think we should move away from the FEMA courses but this year we wanted to meet the call. I recently attended an IMT Operations Chief Course promoted by Health and Human Services and it was an outstanding course, in the future we may have the opportunity to add this to our planners track so we as the ANG can work very well with our civilian counterparts in the time of a crisis. I have been in my new job at the Readiness Center for a short while now and I have a totally new per-spective on how much work has to be accomplished at this level. I invite all of you at some point in your career to take an MPA tour or a stat tour position here at NGB. It will help you in your career growth in all of the MSC tracks, Logistics, Admin, and especially the Readiness portion. I know as a traditional guardsmen it is hard sometimes to step out of our civilian jobs to take on new responsibilities and roles that come available in the ANG, but we can't always say to ourselves, someone else can do that job. If you have a skill set or want to grow a new one, love your Guard job, and your civilian job supports USERRA as it should, take a small MPA tour or Stat tour to help the Guard and grow your MSC skills to a new level. Remember if we don't maintain our skill sets to be Ready, Relevant, and Reliable for the Air Force it doesn't help our Communities or the Air Force in time of emergencies. Thanks and remember "One Team, One Fight" Brett Fehrle, LtCol, USAF, MSC

The MSC Minuteman AIR

NATIONAL

GUARD

MEDICAL

SERVICE

CORPS

Volume 3, Issue 1I May 1, 2010

If you are interested in

becoming a member of

the Society of Medical

Service Corps Officers,

a membership form

has been provided on

page 15.

Mission: Improve and enhance

healthcare administra-

tion in the Air National

Guard

Unite and coordinate

efforts of the Medical

Service Corps Officers

Elevate the practice of

administration.

CONTENTS: 1 —President;’s Column 2 — BIO Col Worcester

4 —Message from CFM 6 —Senior MSC Spotlight

7 —Article: AFMSA/SG Short Tour

8 —Article: Atlanta CERFP

10 —Current Finance Statement

11 —Data Call-IMPORTANT Ques-tion from the Field!!!!

12 —Membership Application

TO CONTACT US President Lt Col Brett Fehrle [email protected], [email protected]; 301-836-8563, cell 405-819-4436

Vice-President Lt Col Paul Loiselle [email protected]; 603-430-2496

Treasurer Capt. Philip Plourde [email protected]; Cell: 678-873-8954

Secretary Lt Col Susan Pangelinan [email protected] ; 707-290-3197

Membership Director Capt Christine Bringard [email protected]; [email protected]; 801-245-2567; bb 406-899-6755

Information Director Lt Col Eterna G. Oehme

[email protected]; 278-7600 Com 301- 836-7600 Operations Director Maj Linda Dunegan [email protected], [email protected]; 907-248-8961

2

The MSC Minuteman Volume 3, Issue 2

COLONEL SALLIE K. WORCESTER Deputy Air Surgeon for Medical Readiness Programs, Resources and Strategy and Chief, Air National Guard Medical Service Corps Career Field Manager

As the Deputy Air Director for Readiness Programs, Resources, Strat-

egy, Communications, Quality Assurance and Compliance, Colonel

Sallie K. Worcester is responsible to the Air Surgeon and the Director,

Air National Guard for the medical readiness of approximately 107,000

ANG members. In addition, she assures DoD, AF, MAJCOMs, TAGs

and NGB of the medical readiness and response capability of the ANG

Medical Service (ANGMS) consisting of 89 medical groups and 10

Aeromedical evacuation squadrons comprised of 5700 medical mem-

bers. She develops and implements policies, plans, programs, training/

exercises, and force structure; manages resources and funds in the amount of $160M; and ensures the

deployability of medical personnel and equipment spanning 54 states and territories and their seam-

less/synergistic fit into Total/Joint Forces. Prior to this position, Colonel Worcester was the Air Na-

tional Guard Medical Forces Advisor to the USAF on all medical policies, plans, programs, readiness,

mobilization activities, inspection and quality assurance programs, training/exercises and benefits/

entitlements that effected the Reserve Components, particularly the Air Reserve Components (ARC)

comprised of the Air National Guard and the Air Force Reserves.

Colonel Worcester began her military career as an enlisted medical technician in the Regular Army.

She was commissioned on 14 January 1984 by the 147th Fighter Wing into the Texas Air National

Guard as a Medical Service Corps (MSC) officer and was a honor graduate of the Health Services

Administration Course. She received the Brigadier Wagner Administrative Excellence Award in

2000, which recognizes Medical Service Corps Officers for making outstanding contributions to the

Air Force Medical Service. She has served in a variety of positions to include personnel specialist,

Director of Medical Logistics, Health Care Administrator and Commander of the 102d Medical

Group.

Colonel Worcester lives in Alexander, Virginia with her husband, who retired July 2006 after serving

38 years in the Massachusetts Air National Guard. Their daughter Brandi is a junior at Bridgewater

State University in Bridgewater, Massachusetts and is a member of the Marines’ 4th Maint Bn, Ft. De-

veins, MA. She recently returned from a deployment to Iraq as an infantry weapons repairwoman.

EDUCATION 1976 North Texas State University, Bachelor of Fine Arts, Magna Cum Laude, Denton, Texas 1992 Western New England College, Masters of Business Administration (MBA), Health Care Management, Springfield, Massachusetts 2006 Interagency Institute Course for Federal Healthcare Executives, Washington, District of Columbia 2007 Military Healthcare System Capstone Course, Washington, District of Columbia

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The MSC Minuteman Volume 3, Issue 2

ASSIGNMENTS 1. August 1979 - September 1981, Medical Specialist, HQ Aviation Battalion, Kitzingen, Germany 2. October 1981- August 1982, Medical Specialist, Ft. Hood, TX 3. March 1983 - March 1984, Personnel Specialist, 147th Fighter Wing, Houston, TX 4. April 1984 - January 1986, Health Services Administrator, 147th Medical Squadron, Houston, Texas 5. February 1986 - December 2000, Health Services Administrator, 102nd Medical Squadron, Otis Air National Guard Base, Massachusetts 6. January 2001 - November 2004, Commander, 102nd Medical Group, Otis Air National Guard Base, Massachusetts 7. December 2004 - May 2009, ANG Medical Forces Advisor to the Air Force Surgeon General, Bolling Air Force Base, Washington, District of Columbia 8. June 2009 - Present, Deputy Air Surgeon for Medical Readiness Programs, Resources and Strategy and Chief, Air National Guard Medical Service Corps, Andrews Air Force Base, Maryland

MAJOR AWARDS AND DECORATIONS Legion of Merit Meritorious Service Medal with two devices Air Force Commendation Medal with one device AF Outstanding Unit Award with two devices Good Conduct Medal National Defense Service Medal with one device Global War on Terrorism Service Medal Army Overseas Service Ribbon Air Force Longevity Service Award with eight devices Armed Forces Reserve Medal with 3 “M” devices Small Arms Expert Marksmanship Ribbon (Rifle) Air Force Training Ribbon Army Service Ribbon

OTHER ACHIEVEMENTS 1981 Soldier of the Month 3rd Aviation Battalion 1984 Health Services Administrator Honor Graduate 1989 Junior Officer of the Year 1999 Special Act or Service Award 1999 Air National Guard Pollution Prevention Individual Award 2000 Brigadier Wagner Administrative Excellence Award Past President, Society of Air National Guard Medical Service Corps Officers

EFFECTIVE DATES OF PROMOTION Second Lieutenant 14 January 1984 First Lieutenant 14 January 1987 Captain 17 January 1989 Major 29 January 1993 Lieutenant Colonel 13 February 1997 Colonel 29 June 2001

(Current as of 20 Mar 2010)

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The MSC Minuteman Volume 3, Issue 2

From the Desk of the ANG MSC Career Field Manager

This has been a very busy year due to the implementation and evolvement of several missions, i.e. Total Force Integration (TFIs), associate wings, BRAC related requirements, Personnel Reliability Program (PRP), CBRNE- Enhanced Response Force Package (CERFP), and the future Homeland Response Force (HRF) mission. Transitioning from a strategic reserve force to an operational reserve force has also generated new requirements. Through your service, innovation and leadership as a professional corps; the embodiment of the Air Force Core Values and the reputation for getting things done, MSC Officers are viewed as a valued asset by the Air Force, TAGs and Guard leadership. These missions require new ways of doing business; changes to directives, policies and laws; innovative ideas/solutions; and new skills and abilities to accomplish them. MSCs have to evolve, learn and improve as a Corps to ensure we are prepared and ready to perform these missions now and in the future. To meet these challenges, the Air Force, Air Force Reserve and Air National Guard MSCs and 4As have developed a Total Force MSC Strategic Plan; reengineered the Heath Services Administration course; and improved Readiness Skills Verification (RSV) training. The ANG MSCs will be revising the ANG MSC Officer Career Development program and Career Guide; restructuring the MSC Council; and giving a facelift to the ANG MSC Community of Practice (COP). This will strengthen our Corps and enhance our ability to support the Department of Defense (DoD), Air Force, and Air National Guard missions (both federal and state). This will ensure we have the knowledge, skills, abilities, experience, training and education needed for success now and in the future.

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The MSC Minuteman Volume 3, Issue 2

Please go to the Air Force Medical Service Knowledge Exchange web site, https://kx.afms.mil/kxweb/dotmil/kj.do;jsessionid=F01F8039C7A2FA4026AB84F9D2571C41?

functionalArea=MedicalServiceCorps&iPlanetDirectoryPro=AQIC5wM2LY4Sfcz6IvxNGu5%

2BTbTfsRROuLBhbVZ7vp%2FRvFY%3D%40AAJTSQACMDE%3D%23

to review the strategic plan and the AF MSC newsletter and web site.

I would like to thank all of the MSCs and 4As that have volunteered to fill our wartime/contingency missions. The Air Force Medical Service appreciates our con-tributions that have provided relief for their personnel, who are continually rotated for wartime/contingency missions. These deployment opportunities are posted on the ANG MSC COP. I look forward to working with you to meet the challenges and opportunities we have ahead of us. Thank you for all that you do! In the words of the AF MSC Corps Chief, Brigadier General Miller “Service is our middle name.”

Colonel Sallie K. Worcester

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The MSC Minuteman Volume 3, Issue 2

Senior MSC Spotlight

COLONEL SANDRA L. CARLSON

Colonel Sandra L. Carlson was commissioned in 1980 and is a graduate of the United States

Air Force Academy. She received her Masters Degree in Human Factors Engineering from North-

eastern University in 1983. Colonel Carlson served on active duty from 1980 to 1988 as a Sys-

tems Acquisition Officer working on tactical command and control systems. She was assigned to

the Electronic Systems Division, Hanscom AFB, MA from 1980-1984. From 1984 to 1985, she par-

ticipated in the Education With Industry Program at the McDonnell Douglas Corporation in St

Louis, MO. Following the completion of this program, Colonel Carlson was assigned to Headquar-

ters Air Force Space Command as a Plans Officer in the Missile Warning Directorate.

Colonel Carlson left active duty in 1988 and became an Admissions Liaison Officer for the

Air Force Academy and AFROTC programs. In 1989, Colonel Carlson joined the Minnesota Air Na-

tional Guard and was re-commissioned as a Medical Service Corps Officer in the 109th Aeromedical

Evacuation Squadron where she served as the Operations Officer through 1993. Colonel Carlson

is a Persian Gulf War veteran. In 1993, Colonel Carlson became the Commander of the 109th

Aeromedical Evacuation Squadron. In 1999, Colonel Carlson became the Commander of the 133rd

Medical Squadron. Colonel Carlson served as the ANG Medical Readiness Assistant to the USAFE

Surgeon from 2001 through 2004. She served as the sole ANG member of the HQ USAFE Sur-

geon’s staff during the initial phase of Operation Iraqi Freedom. On 1 June 2004, she became

the Air National Guard Assistant to the Air Force Space Command Surgeon. She currently serves

as the liaison officer between the National Guard Bureau and HQ Air Force Space Command for

medical issues that affect ANG space and cyber missions.

Colonel Carlson’s civilian work experience is in sales and marketing. She has worked for

Honeywell, Alliant Techsystems, and National Computer Systems.

7

The MSC Minuteman Volume 3, Issue 2

AFMSA/SG Short Tour Opportunity in the NCR

(National Capital Region)

Maj Steve Sigler

On February 7th I started my short tour at the Air Force Medical Support Agency/Surgeon General’s

Office. My duty title is Medical Homeland Defense/Civil Support Action Officer. Being a part of the “big

picture” has been quite an experience. My whole 19 year career has been spent as a traditional guardsman

serving in the 167th MDG out of Martinsburg, WV. I’ve deployed to Germany, Honduras, Katrina, Iraq and

Afghanistan but have never been a part of the “Air Staff.” For a Traditional Guardsman, working for the AD

on Air Staff is a terrific opportunity. Not only do I learn about the AD Way, they can learn and have a better

understanding of the challenges and opportunities of an Air Guard member.

In my 2 months of employment, I have learned a great deal and experienced things that would never

have taken place without stepping up to the plate and volunteering for this position. On the AD side, I’m

working on NDMS (National Disaster Medical Support) issues such as Federal Coordinating Centers and Pa-

tient Retrieving Centers. Another area of responsibility is DSCA (Defense Support to Civil Authorities). This

includes giving a “guard view” to the medical segment of CST’s, CERFP’s, HRF’s and NCERF’s. I have also

been a part of ESF #8 working groups, attended All Hazard Response Training Exercises, Disaster Air Staging

Facility Exercises and have had many taskers reviewing CONPLANS and AF Regulations. At the beginning of

this tour a senior MSC asked me “do you feel as though you have a hose from a fire hydrant connected to your

mouth?” This was exactly how I felt but it eventually started to slow down and make more sense. I realize by

no means will I be an expert after 6 months but the experience should be invaluable for my normal MSC duties

at my MDG. Even though I’m on this Title 10 assignment I have also been performing my UTA weekend

MSC duties and WVCERFP missions. It is a challenge but will be well worth it in the long run.

In summary, I would encourage all MSC’s to volunteer for any opportunity that presents itself. The

overseas duties are a great experience and worthwhile mission but a tour at NGB or in the NCR is quite an ex-

perience as well. I feel very blessed to have had the opportunity to have had both!

Any questions that you may have please feel free to contact me at [email protected] or

301-992-8686.

8

The MSC Minuteman Volume 3, Issue 2

ATLANTA CBRNE INCIDENT – DELTA AIRLINES HANGER

On Sunday 21 Feb 2010 at 0900 the GA – CERFP unit was called into action.

This unit is a Chemical, Biological, Radiological, Nuclear, and High-Yield Explo-

sive Response Force Package that provides an Incident Commander (IC) capability

in Search & Extraction (S&E), Decon, Medical, Command & Control, and Fatality

Search & Recovery (FSRT). The GA-CERFP is just one team out of 17 teams in

the country, teams the NG CERFPs have been established in 17 states to

date: California, Colorado, Florida, Georgia, Hawaii, Illinois, Massa-

chusetts, Minnesota, Missouri, Nebraska, New York, Ohio, Pennsylvania, Texas, Virginia, Washington, and

West Virginia. Following the Alert at 0900 hours, Airman and Soldiers from the Georgia National Guard were recalled and instructed to leave

their home of record and head to the nearest assemble area, which are in Savannah, Warner Robins, Augusta, and Kennesaw

Georgia. By 1100, Airman and Soldiers were preparing their vehicles and equipment for departure to the incident site.

The Commander, MAJ Jeff Carlyle, gave a mission brief with the situation being that the FBI had informed the IC that three

inbound Delta flights had been rerouted to ATL Airport and were expected to land late on 21 Feb. All inbound flights were

coming from Yemen and intel suspected that the three planes had terrorist on them. Intel further showed that one inbound

flight possible had Sarin Gas aboard with a secondary explosion device.

At 1300, the JTF launched an ADVON team to the staging area located at 3399 International Blvd in Hapeville, GA. The team

arrived at 1400 and started making contact with the IC along with making arrangement to receive the main body of 225 Airman

and Soldiers. By 1800, the JTF 781 arrived at the staging site with 225 responders and over 50 pieces of rolling stock.

Around 1800, the JTF Commander launched forward with the Advon team to receive the in-brief from the IC. Upon arrival at

the Delta hanger located on Aviation Blvd, the team was faced with a new challenge. A 767 Delta Aircraft was loaded with

152 passengers, the FBI briefed the team that a terrorist was on the plan and was threatening to spray the occupants with Sarin

Gas and then cause an explosion.

MAJ Carlyle organized his response while working with the IC, FBI and the

lead Delta agent Mr. Bill Cook. The JTF 781 CBRNE began to occupy the

incident site. Decon established water operations using several Atlanta Fire

tanker trucks and before long the FBI recovered the assailant. Next, the EOD

was sent forward to clear the device, which was safely mitigated in 14 minutes.

Following this activity, S&E and FSRT entered the aircraft in the required

Level-C PPE and started carrying occupants out to the Decon line. Decon

cleaned the occupants and Medical performed any necessary treatment. The

Command and Control Element (C2) preformed precisely as trained by track-

ing all CBRNE response activities at the incident site.

By 0100 on Monday 22 February 2010, the JTF 781 successfully recovered all 152 passengers

aboard the Delta Aircraft. Shortly thereafter, this training event was terminated; the JTF 781

CBRNE packed their equipment and departed the incident site at 0300 – An outstanding eighteen

hours of training.

Special Thanks goes out to many, but particularly to the Georgia State Defense Force for provid-

ing 52 live role-players, Atlanta Fire, Atlanta TSA and especially Delta Airlines (Mr. Bill Cook

and Mr. Bob Morales). Without the utilization of the Delta Airlines hanger as a training plat-

form, this event would not have been possible.

Capt Philip Plourde

MSC, Air National Guard

Deputy OIC / Med Plans Officer

JTF 781 CBRNE

The next photo is an example of a CERFP set-up, two days following the above scenario the GA-CERFP conducted an exercise

at Naval Station Jacksonville, they worked with the Naval Air Station Fire, Civilian EMS and the Florida CERFP team.

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The MSC Minuteman Volume 3, Issue 2

WHY DID YOU JUST READ THIS ARTICLE? As stated above, currently there is 17 CERFP team, but there is some current work taking place with-in your state that may make you part of a CERFP type of organization. Currently, NGB is working on developing 10 Homeland Response Force Packages; within in this package a CERFP is in bedded. So our country will eventually have 27 CERFP teams.

WHY IS THIS IMPORTANT? Well Air National Guard Medical is the primary Med unit for a CERFP and MSC officers are largely needed for the coordination of the team’s involvement. Brush up on your ICS courses and be ready for this upcoming Homeland Re-sponse mission.

10

The MSC Minuteman Volume 3, Issue 2

2010 Financial

Statement

Society of Air National Guard Medical Service

Corps Officers

STARTING BALANCE $ 1,357.57

REVENUE:

Membership Dues 2010 $ 520.00

Promotional Merchandise $ 55.00

TOTAL REVENUE $ 575.00

EXPENSES:

Readiness Frontiers $ -

Administrative $ -

ANGMSC Symposium $ -

Promotional Merchandise $ -

Miscellaneous Awards $ -

Monthly Bank Fee $ -

TOTAL EXPENSES $ -

NET ANNUAL REVENUES $ 575.00

BANK BALANCE 20 APRIL 10 $ 1,932.57

CASH AVAILABLE $ 1,932.57

MERCHANDISE:

COINS @ $5 EACH FOR 83 COINS $ 415.00

SHIRTS @ $5.75 EACH FOR 23 $ 120.75

LONG SLEEVE SHIRTS @ $9.75 EACH FOR $ -

SWEATSHIRTS @ $12.75 EACH FOR 12 $ 153.00

TOTAL MERCHANDISE: $ 688.75

TOTAL CASH & MERCHANDISE: $ 2,621.32

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The MSC Minuteman Volume 3, Issue 2

OPPORTUNITIES

Members as Volunteers to help with MSC Issues, etc. (How to get involved?) - Examples may be helping with the organization of Readiness Frontiers, newsletters, website, exer-cise planning or coordination, MSC Symposium, etc. - Have an article you would like published here? Send it in!

***QUESTION FROM THE FIELD***

A unit is requesting some information as soon as you can send! Send to me and I’ll for-ward on. THANK YOU! They are looking for a Table of Contents for the following pro-grams: Force Management PIMR Immunizations Homeland Defense

MSC Membership Information

Along with turning in your membership application and dues to Capt Plourde, please send me the following information: - Have you attended any MSC courses (ie, Medical Readiness Mgmt Course, SORTS, Joint Planning Courses, civilian Incident Command, DMLSS, etc.)

READINESS FRONTIERS:

Watch the Head’s Up for information. Hope to see you all there! If you do not get the Head’s Up get in touch with your Senior MSC. On the docket is RSV completion! Read the messages from Col Worcester and Lt Col Fehrle. While we’re there we can discuss thoughts from the field on future Jr. MSC Symposium’s. Be ready for July’s issue! We’ll have highlights from Readiness Frontiers, an article from a member deployed to the AOR, and more!

To keep receiving this Newsletter go to the last page and become a Member!

Capt. Christine Bringard [email protected]; Mobile 406-899-6755

12

The MSC Minuteman Volume 3, Issue 2

MSC SOCIETY MEMBERSHIP APPLICATION New Application Renewal Change of Information

I. To Be Completed by All Applicants: Name/Rank Unit Number & State AE/MDG Position (Commander, Administrator, MAO, CERFP, Readiness, Logistics, etc.) Significant Additional Duties (Self-Inspection, Awards & Decs, Education and Training, etc.) Civilian Occupation Title

II. To Be Completed by New Applicants or To Indicate Any Changes: Address (Unit/Home/Work):

Telephone ( _ )( __ )( _______ ) Fax Number (___ )( __ )( _______ ) E-Mail Address I prefer to receive correspondence at my (circle one): Home Office Unit

III. Authorization to Release Information: I (Circle One) do/do not hereby provide personal information listed above to the Society of Air National Guard Medical Service Corps Officers for the purpose of inclusion into a published Medical Service Corps (MSC) Directory. I understand the MSC Directory will be released to the ANG Medical Units and the MSC ANG Society members.

Signature: _____ ___ Date:

IV. Payment: Dues for the society are payable to the Treasurer and must be paid by December 31st for the next calendar year. Make checks pay-able to The Society of Air National Guard Medical Service Corps Officers (or abbreviate with ANGMSC).

Amount Due: $20.00 for 0-1 through 0-3 and $30.00 for 0-4 and Up Mail Payment to: Capt Philip Plourde, 2055 Robertford Way, Powder Springs, GA 30127

V. Receipt: If needed, tear off the portion below and save it for your records.

The SOCIETY of AIR NATIONAL GUARD MEDICAL SERVICE CORPS OFFICERS

Amount Paid________________ Date Paid ________________

Paid by Cash or Check Number ___________

Signature of Treasurer___________________________________________________