Contact Us

If you believe you have been harmed as a result of the Behr-Dayton VOC plume
and would like to contact us, please complete this form.

  First Name  
  Last Name  
Mailing Address
  Street
  City  
  State Zip  
Contact Information
  Home phone  
  Cell phone  
  work phone  
  e-mail  
Details
Have you retained another lawyer to help you with this lawsuit? Yes           No  
       
Do you currently or have you ever lived in McCookField?
Currently:
 Yes No  
In the past:
 Yes No   
     
If not at the same address as given, what is the address?

 
     
From month/year to month/year  
     
Names of other adult McCook Field residents at that address
   
Identify all children in the home under age 18.
Child 1 Name
 Age
Child 2 Name
 Age
Child 3 Name
 Age
Child 4 Name
 Age
     
Has anybody who lived in your McCook Field residence been diagnosed with the following?:
INJURY
Liver Cancer  Liver Injury
Kidney Cancer Kidney Injury
Lung Cancer
Lung Injury
Injuries to your nerves? (Identify)
Other serious disease: