Segs4Vets Recipient Registration

Segs4Vets Recipient Registration

If you have not been contacted by a Segs4Vets / DRAFT Team Member asking you to complete this Registration form, please do not complete this form. To apply for the Segs4Vets program.....Click here

Please complete all fields on the registration form. Double check your responses before you click on the submit button. Upon successful completion of this form you will be re-directed to the Confirmation page of our website, and receive a confirmation email, at the email address you provide on the form.

Segs4Vets Recipient Registration Form- (Please fill out ALL fields)

Have you been invited for training:

First Name:

Last Name:

Current Street Address:

Current City:

Current State:

Current Zip Code:

Phone Number:

Email:

Branch of Service:

Rank:

Are you on Active Duty:

Date of Injury:

Will you have a guest coming with you:

Will you fly or drive to the event:

Your Legal First Name for Airline Ticket:

Your Legal Last Name for Airline Ticket:

Your Gender:

Your Birth Date:

Select Date

Guest's Legal First Name for Airline Ticket:

Guest's Legal Last Name for Airline Ticket:

Your Guest's Gender:

Guest's Birth Date:

Select Date

Your Departure Airport:

Presentation City:

Hotel Accommodation:

Dinner Guest:

Your Dinner Guest's full name:

Ceremony Guests:

Your Shirt Size:

Military Medals Awarded:

Emergency Contact's Full Name:

Emergency Contact's Phone Number:

Emergency Contact's Relationship:

Guest's Emergency Contact's Full Name:

Guest's Emergency Contact's Phone Number:

Guest's Emergency Contact's Relationship:

Digital Signature (REQUIRED):

Click Here Once To Submit Application