Veteran Application

Veterans who wish to attend need to fill this form out in its entirety, not leaving any field blank, and hit the Submit button.

First Name

Middle Initial

Last Name

Name to use on Name Badge

Date of Birth

Phone Number

Is this a mobile phone?

Physical Address (street address, city, state, zip code)

Mailing Address (street address, city, state, zip code)

Are you a resident of a senior living community?

If yes, what is the name of the community?

Your email address

If you do not have an email address OR you do not check your email regularly, please provide the following information of someone who can easily get in touch with you. If you live in a senior living community, please include the contact information for the staff member who is coordinating veterans for your community.
Contact Name

Contact email

Contact Phone Number

What is your preferred method for receiving information and updates for this event?

Shirt size?

Emergency Contact Name for Day of Event

Emergency Contact Relationship

Emergency Contact Mobile Phone

Family Members:
While we understand family support is important, due to our limited capacity and the nature of the program, this event is limited to Veteran attendees only. Your family may contact our team to provide suggestions on how we can best support you on the day of the event. You may reach out to us through the Contact Form of this website.
Military Service History:
For the purpose of this event, our definition of a Veteran is: A person who has served at least 180 days of active duty in one of the armed forces, and who has been discharged with an Honorable, General, or Medical discharge. Please initial here that you were discharged with one of these types of discharges.

Personnel who are currently on active-duty status may also apply.
If you have served in more than one branch of service, you may indicate so by typing them both in (for example: Army, Navy) the field for Branch of Service. If you have more than one range of service dates, you may type them in (for example: 1976-1981, 1985-1989) in the field for Dates of Service.
Branch of Service

Dates of Service

WWII Vets only: Your hometown when entering service:

Select your current rank OR your rank when discharged.

If you selected Other, please type it in below.

Medical History:
Can you walk unassisted?

Do you use mobility equipment?

If yes, please indicate device:

Do you have any food allergies?

If you selected Yes, please describe it below.

Personal Caregivers:
Attendees may request to have a personal caregiver on premises during the event. Personal caregivers must wait in our Standby Lounge in case there is a need for personal assistance.
Do you require a personal caregiver?

Caregiver Name

Caregiver email address

Caregiver Phone Number

Review Carefully and sign:
I understand and agree that:
1) All medical insurance and liability is the obligation of each participant.The Mission to Honor Veterans event, nor affiliated companies and people, does NOT provide medical care for this event beyond basic first aid. I understand and accept responsibility for any illnesses or injuries incurred while participating in the Mission to Honor Veterans activities.
2) I hereby give consent to Mission to Honor Veterans to photograph, videotape, or otherwise digitally record and use images and/or sound recordings of myself to use in any public media, including radio, television, internet, social media, print, or in any of the organization’s publications, productions, or posts. I understand that the intended use of such images and information is solely for the purpose of advertising, marketing, fundraising and/or the promotional and public awareness purposes for the organization. I hereby waive any rights or interest in the images or recordings, and I waive any rights to compensation or ownership of them. I further acknowledge that there is no guarantee that any or all the images or recordings will be used in any released media.
Veteran’s Signature (typing out your full name constitutes your signature)

Signature Date (typing out the full date constitutes the date)

Thank you for applying for our 2024 Mission to Honor Veterans event. Submitting an application does NOT mean you can attend. Space is limited and we will contact you IF you have been selected to be honored at this year’s event.