Honoring America's Veterans
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701-220-1568
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On-line Veteran Application Form
Home
Applications
Veteran Application
On-line Veteran Application Form
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Flight Status
Pre
Current
Past
Alternate
Deceased
No
Yes
Trip Number
NA
Trip 3
Trip 4
Trip 5
Trip 6
Trip 7
Bus Color
Green
Orange
Purple
Yellow
Seat
Travel Companion
First
Last
Today's Date
Veteran's Name
*
First
Middle
Last
AS IT APPEARS ON YOUR PHOTO ID* (This is used for airline purposes)
PERSONAL DATA / SERVICE HISTORY
Which war/conflict are you a Veteran of?
*
World War II
Korean War
Vietnam War
Berlin Crisis
Desert Storm
GWOT
Currently, we are only accepting applications for veterans who served during the WWII, Vietnam and Korean war periods.
What years did you serve?
*
Layout
Branch of Service:
*
Rank:
*
Layout
Birth Date:
*
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YYYY
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1922
1921
1920
Age:
*
Nickname:
*
Gender:
*
Male
Female
Veteran's Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
County
*
Layout
Veteran's Phone (Day)
*
Veteran's Phone (Evening)
*
Veteran's Phone (Cell)
Email Address
*
If you enter a valid email address, you will receive an email confirmation after submitting this application. If you do not have an email address, provide an email address of a family member.
Do you use a wheelchair full-time?
*
Yes
No
Do you think you may need a wheelchair for this trip for any amount of time?
*
Yes
No
*Walkers or motorized scooters are not allowed, canes ARE allowed. We will gladly provide you with a wheelchair for any amount of time you need it.
Do you have a TERMINAL ILLNESS?
*
Yes
No
Describe your terminal Illness:
*
Submit