| Contact Information | |
|---|---|
| First Name | Phill |
| Last Name | Burke |
| Address | |
| City | Gloucestershire |
| State | |
| Province | England |
| Zip/Postal Code | |
| Country | United Kingdom |
| Home Phone | - |
| Work Phone | - |
| Fax | |
| monkeyfiend@hotmail.com | |
| Alternate Email | monkeyfiend@hotmail.com |
| Website Address | |
| Gender | Male |
| Injury Information | |
| The injured person is | Self |
| Name of Injured | Phill - Burke |
| Date of Injury | 09/07/2006 |
| Type of Injury | Traumatic |