JavaScript must be enabled for online registration.
Veteran Information
First Name
Middle Name
Last Name
Nickname
(if used)
Date of Birth
Month
Jan.
Feb.
Mar.
Apr.
May
June
July
Aug.
Sept.
Oct.
Nov.
Dec.
Gender
Male
Female
Contact Information
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virgin Islands
Washington
West Virginia
Wisconsin
Wyoming
Zipcode
County
Daytime Phone
Evening Phone
Mobile Phone
Email Address
Service History
Branch of Service (check all that apply)
Army
Navy
Air Force
Marines
Coast Guard
Other
Conflicts during your service (check all that apply)
WW II (Dec. 7, 1941 - Dec. 31, 1946)
Korea (June 29, 1950 - Jan. 31, 1955)
Vietnam (Feb. 28, 1961 - May 8, 1975)
Lebanon/Grenada (Aug. 24, 1982 – Dec. 15, 1983)
Panama (Dec. 20, 1989 – Feb. 13, 1990)
Gulf War / War on Terrorism (Aug. 2, 1990 - Present)
Other Dates
Note: Please see the
attached CRS document
for any clarification of Conflict dates
Service Dates / Comments:
Additional Information
Have you been the recipient of a previous Honor Flight trip or visited the WW II, Korean, Marine Corps or Vietnam War Memorials?
Yes
No
T-Shirt Size
S
M
L
XL
XXL
XXXL
XXXXL
Other
If you wish to have someone that meets the criteria of a "QUALIFIED GUARDIAN" accompany you, please list their full first, middle and last name, relationship and contact information here:
NOTE: The Guardian MUST submit an application as well.
Remarks / Comments:
How did you hear about Honor Flight?
Submit Application