Veteran Application

First name

Please check your name on your driver's license or gov. ID. This is for TSA, no nic names.

Middle name (N/A if none)

Last name

Name you go by if not your first name

Birthday

Month

Day

Year

Phone Number

Multi-line address

Country/Region

Address

City

Zip / Postal code

T-shirt Size

What Era did you serve in?

What branch did you serve in?

Email

Enlisted City

Dates of Service

Military Duties

Emergency Contact (name & number)

Guardian name ( must be under 65) & phone number. If unknown, leave blank.

Tell us about any medical issues. Examples - Surgeries, sight loss, terminal illness, mobility issues, cancer etc.

Have you been diagnosed with Alzheimer's/Dementia?

Yes

No

Do you reside in a nursing home?

Yes

No

If you are filling out this form on a Veteran's behalf, are they aware they have been signed up?

Yes

No

Please select if you are applying for a regular Honor Flight to D.C. trip or Operation Penguin. Please look at the Operation Penguin tab for more information.

Washington D.C.

Operation Penguin