Name

First Name

Last Name

Email Address

Branch of Service

Please list your branch of service.

Dates of Service

Put in the dates of Active Duty Service in the form of: MM/DD/YYYY to MM/DD/YYYY

Honorable Discharge?

Currently we are only able to provide services to Veterans who have an Honorable Discharge.

Yes

Combat Veteran?

Please note that we may ask you to prove your service and anyone who provides false information will be prosecuted under the Stolen Valor Act.

Yes

Service Connected Disability rated over 50%?

Again, we may ask you to prove the rating of service connected disability.

Yes

Type of events interested in

List 2 types of events you would like to attend: Basketball, Football, Baseball, Hockey, Family (Disney on Ice), Concert, etc. If there is a specific team, show or concert, you can list it here. There is no guarantee that you will be able to attend the event you list.

Additional Information

Please list any additional information that may help us determine which events may work best for you. Things such as: Family Size, Age of Children, Service Dog, conditions requiring accommodation, or any other factors that you would like to share. If you have been dealing with any specific issues that you feel would be helpful to attend with others facing similar issues please feel free to share. Finally, if there are any specific programs you would like to learn about in terms of Veterans benefits or assistance, please share and we will attempt to coordinate with those providers to have some information made available.