IDENTIFICATION AND PERSONAL HISTORY (Nuclear Weapons Test Participant) Name and address: Age: Sex: Birthdate: Birthplace: Places lived since birth: Education: Grade School: 12 3 4 High School: 12 3 4 Beyond High School: 1 2 5 3 6 7 8 4 5 or more__ Marital Status: Single Widowed Marr ied Separated Divorced Remarr ied Ea fk gf by. ~— me lume