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DD Form 11722 Download Fillable PDF or Fill Online Application for
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Defense Enrollment Eligibility Reporting System (DEERS)
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These benefits and privileges include, but are not limited to,. Web please submit with enrollment form by fax to: Northern california or southern california region individual plan who can use this form? Registration in the defense enrollment eligibility reporting system (deers) is essential for your family to be eligible for. Facility/provider name admission date discharge date child’s name gender birthdate.
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