Honor Flight of Southern Colorado | Veteran Registration Form

Veteran Information

First Name

Middle Name

Last Name

Nickname (if used)

Date of Birth

Gender

Male Female

Contact Information

Street Address

City

State

Zipcode

County

Daytime Phone

Evening Phone

Mobile Phone

Email Address

Emergency Contact

The Emergency Contact should be someone available on the day of the trip.

First Name

Last Name

Relationship

City

State

Zipcode

Daytime Phone

Evening Phone

Mobile Phone

Email Address

Medical Information

Do you use mobility equipment? (check all that apply)

Cane

Scooter

Walker

Wheelchair

Wheelchair (Wide)

Do you use oxygen at any time?

Yes No

Are you visually impaired?

Yes No

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

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.

Why are you volunteering for Honor Flight?

Remarks / Comments:

How did you hear about Honor Flight?