Veterans Registration Form | One Community Now

Personal Information

Name*

First Last

Phone*

Birth Date*

Age*

Gender*

Email

County*

Address or Shelter location

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Branch of Service*

Years Served YYYY-YYYY*

Are you bringing a service dog?

What kind of service animal?

If you are planning to bring any family members to the Stand Down please provide their name and date of birth.

What size pants/shorts do you wear?

What size shoes/boots do you wear? (for overnight vets only)

What size t-shirt do you wear?

Are you in a Wheelchair or have limited mobility?*

Will you need special accommodations while attending the Stand Down?*

If Yes, please explain.

Where are you currently living?*

If you are providing your own transportation to the Stand Down, do you plan on staying overnight?

Will you need transportation to the Stand Down?*

All pick-ups will be on Thursday the 18th and all drop-offs on Sunday the 21st. Please select from a stop below.

Alpha Bus #1 - Pinellas County

Alpha Bus #2 - Pinellas/Pasco County

Bravo Bus #1 - West Pasco County

Charlie Bus #1 - East Pasco County

Delta Bus #1 - Hernando County

Echo Bus #1- Hillsborough

Florida Wheel Chair Transport

FL License Number

Case Number (if applicable)

Court Cost Due?

What are the charges? (if known)