{"id":505,"date":"2019-12-05T21:23:29","date_gmt":"2019-12-06T03:23:29","guid":{"rendered":"https:\/\/westernndhf.org\/?page_id=505"},"modified":"2024-01-26T21:35:46","modified_gmt":"2024-01-27T03:35:46","slug":"on-line-veteran-application-form","status":"publish","type":"page","link":"https:\/\/westernndhf.org\/?page_id=505","title":{"rendered":"On-line Veteran Application Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"505\" class=\"elementor elementor-505\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-f4db5ec elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"f4db5ec\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-fbc5efd\" data-id=\"fbc5efd\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3ff5183 elementor-widget elementor-widget-wpforms\" data-id=\"3ff5183\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-1802\"><form id=\"wpforms-form-1802\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1802\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F505\" data-token=\"8b6c1cfe461b1a6888a055bbec489b0d\" data-token-time=\"1780516674\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-1802-field_153-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"153\"><div id=\"wpforms-1802-field_153\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-1802-field_153-error\"><h1>Veteran Application<\/h1>\n<p>Updated:\u00a0 1 November 2025<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1802-field_121-container\" class=\"wpforms-field wpforms-field-radio hide wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"121\"><fieldset><legend class=\"wpforms-field-label\">Flight Status<\/legend><ul id=\"wpforms-1802-field_121\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1802-field_121_1\" name=\"wpforms[fields][121]\" value=\"Pre\" aria-errormessage=\"wpforms-1802-field_121_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_121_1\">Pre<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_121_2\" name=\"wpforms[fields][121]\" value=\"Current\" aria-errormessage=\"wpforms-1802-field_121_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_121_2\">Current<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_121_3\" name=\"wpforms[fields][121]\" value=\"Past\" aria-errormessage=\"wpforms-1802-field_121_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_121_3\">Past<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_121_4\" name=\"wpforms[fields][121]\" value=\"Alternate\" aria-errormessage=\"wpforms-1802-field_121_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_121_4\">Alternate<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1802-field_148-container\" class=\"wpforms-field wpforms-field-radio hide wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"148\"><fieldset><legend class=\"wpforms-field-label\">Remove from List<\/legend><ul id=\"wpforms-1802-field_148\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1802-field_148_1\" name=\"wpforms[fields][148]\" value=\"No\" aria-errormessage=\"wpforms-1802-field_148_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_148_1\">No<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_148_2\" name=\"wpforms[fields][148]\" value=\"Yes\" aria-errormessage=\"wpforms-1802-field_148_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_148_2\">Yes<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1802-field_134-container\" class=\"wpforms-field wpforms-field-radio hide wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"134\"><fieldset><legend class=\"wpforms-field-label\">Deceased<\/legend><ul id=\"wpforms-1802-field_134\"><li class=\"choice-1 depth-1 wpforms-selected\"><input type=\"radio\" id=\"wpforms-1802-field_134_1\" name=\"wpforms[fields][134]\" value=\"No\" aria-errormessage=\"wpforms-1802-field_134_1-error\"   checked='checked'><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_134_1\">No<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_134_2\" name=\"wpforms[fields][134]\" value=\"Yes\" aria-errormessage=\"wpforms-1802-field_134_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_134_2\">Yes<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1802-field_125-container\" class=\"wpforms-field wpforms-field-radio hide wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"125\"><fieldset><legend class=\"wpforms-field-label\">Trip Number<\/legend><ul id=\"wpforms-1802-field_125\"><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_125_6\" name=\"wpforms[fields][125]\" value=\"NA\" aria-errormessage=\"wpforms-1802-field_125_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_125_6\">NA<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_125_10\" name=\"wpforms[fields][125]\" value=\"Virtual\" aria-errormessage=\"wpforms-1802-field_125_10-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_125_10\">Virtual<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_125_1\" name=\"wpforms[fields][125]\" value=\"Trip 3\" aria-errormessage=\"wpforms-1802-field_125_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_125_1\">Trip 3<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_125_2\" name=\"wpforms[fields][125]\" value=\"Trip 4\" aria-errormessage=\"wpforms-1802-field_125_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_125_2\">Trip 4<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_125_3\" name=\"wpforms[fields][125]\" value=\"Trip 5\" aria-errormessage=\"wpforms-1802-field_125_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_125_3\">Trip 5<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_125_4\" name=\"wpforms[fields][125]\" value=\"Trip 6\" aria-errormessage=\"wpforms-1802-field_125_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_125_4\">Trip 6<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_125_5\" name=\"wpforms[fields][125]\" value=\"Trip 7\" aria-errormessage=\"wpforms-1802-field_125_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_125_5\">Trip 7<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_125_7\" name=\"wpforms[fields][125]\" value=\"Trip 8\" aria-errormessage=\"wpforms-1802-field_125_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_125_7\">Trip 8<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_125_8\" name=\"wpforms[fields][125]\" value=\"Trip 9\" aria-errormessage=\"wpforms-1802-field_125_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_125_8\">Trip 9<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_125_9\" name=\"wpforms[fields][125]\" value=\"Trip 10\" aria-errormessage=\"wpforms-1802-field_125_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_125_9\">Trip 10<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1802-field_124-container\" class=\"wpforms-field wpforms-field-radio hide wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"124\"><fieldset><legend class=\"wpforms-field-label\">Bus Color<\/legend><ul id=\"wpforms-1802-field_124\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_124_1\" name=\"wpforms[fields][124]\" value=\"Green\" aria-errormessage=\"wpforms-1802-field_124_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_124_1\">Green<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_124_2\" name=\"wpforms[fields][124]\" value=\"Orange\" aria-errormessage=\"wpforms-1802-field_124_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_124_2\">Orange<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_124_3\" name=\"wpforms[fields][124]\" value=\"Purple\" aria-errormessage=\"wpforms-1802-field_124_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_124_3\">Purple<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_124_4\" name=\"wpforms[fields][124]\" value=\"Yellow\" aria-errormessage=\"wpforms-1802-field_124_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_124_4\">Yellow<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1802-field_126-container\" class=\"wpforms-field wpforms-field-text hide\" data-field-type=\"text\" data-field-id=\"126\"><label class=\"wpforms-field-label\" for=\"wpforms-1802-field_126\">Seat<\/label><input type=\"text\" id=\"wpforms-1802-field_126\" class=\"wpforms-field-small\" name=\"wpforms[fields][126]\" aria-errormessage=\"wpforms-1802-field_126-error\" ><\/div><div id=\"wpforms-1802-field_132-container\" class=\"wpforms-field wpforms-field-name hide\" data-field-type=\"name\" data-field-id=\"132\"><fieldset><legend class=\"wpforms-field-label\">Guardian<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-1802-field_132\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][132][first]\" aria-errormessage=\"wpforms-1802-field_132-error\" ><label for=\"wpforms-1802-field_132\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1802-field_132-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][132][last]\" aria-errormessage=\"wpforms-1802-field_132-last-error\" ><label for=\"wpforms-1802-field_132-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-1802-field_127-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"127\"><label class=\"wpforms-field-label\" for=\"wpforms-1802-field_127\">Today&#039;s Date<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-1802-field_127\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-small\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][127][date]\" aria-errormessage=\"wpforms-1802-field_127-error\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-1802-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">Veteran&#039;s Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-1802-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" aria-errormessage=\"wpforms-1802-field_1-error\" aria-describedby=\"wpforms-1802-field_1-description\" required><label for=\"wpforms-1802-field_1\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-fifth\"><input type=\"text\" id=\"wpforms-1802-field_1-middle\" class=\"wpforms-field-name-middle\" name=\"wpforms[fields][1][middle]\" aria-errormessage=\"wpforms-1802-field_1-middle-error\" aria-describedby=\"wpforms-1802-field_1-description\" ><label for=\"wpforms-1802-field_1-middle\" class=\"wpforms-field-sublabel after\">Middle<\/label><\/div><div class=\"wpforms-field-row-block wpforms-two-fifths\"><input type=\"text\" id=\"wpforms-1802-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" aria-errormessage=\"wpforms-1802-field_1-last-error\" aria-describedby=\"wpforms-1802-field_1-description\" required><label for=\"wpforms-1802-field_1-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><div id=\"wpforms-1802-field_1-description\" class=\"wpforms-field-description\">AS IT APPEARS ON YOUR PHOTO ID* (This is used for airline purposes)<\/div><\/fieldset><\/div><div id=\"wpforms-1802-field_150-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"150\"><fieldset><legend class=\"wpforms-field-label\">I am interested in the Virtual Honor Flight (if you cannot travel)<\/legend><ul id=\"wpforms-1802-field_150\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1802-field_150_1\" name=\"wpforms[fields][150][]\" value=\"Yes\" aria-errormessage=\"wpforms-1802-field_150_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_150_1\">Yes<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1802-field_6-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"6\"><div id=\"wpforms-1802-field_6\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-1802-field_6-error\"><h4>PERSONAL DATA \/ SERVICE HISTORY<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1802-field_2-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"checkbox\" data-field-id=\"2\"><fieldset><legend class=\"wpforms-field-label\">Which war\/conflict are you a Veteran of? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1802-field_2\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1802-field_2_1\" name=\"wpforms[fields][2][]\" value=\"World War II\" aria-errormessage=\"wpforms-1802-field_2_1-error\" aria-describedby=\"wpforms-1802-field_2-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_2_1\">World War II<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1802-field_2_2\" name=\"wpforms[fields][2][]\" value=\"Korean War\" aria-errormessage=\"wpforms-1802-field_2_2-error\" aria-describedby=\"wpforms-1802-field_2-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_2_2\">Korean War<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-1802-field_2_3\" name=\"wpforms[fields][2][]\" value=\"Vietnam War\" aria-errormessage=\"wpforms-1802-field_2_3-error\" aria-describedby=\"wpforms-1802-field_2-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_2_3\">Vietnam War<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-1802-field_2_4\" name=\"wpforms[fields][2][]\" value=\"Berlin Crisis\" aria-errormessage=\"wpforms-1802-field_2_4-error\" aria-describedby=\"wpforms-1802-field_2-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_2_4\">Berlin Crisis<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-1802-field_2_5\" name=\"wpforms[fields][2][]\" value=\"Desert Storm\" aria-errormessage=\"wpforms-1802-field_2_5-error\" aria-describedby=\"wpforms-1802-field_2-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_2_5\">Desert Storm<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-1802-field_2_6\" name=\"wpforms[fields][2][]\" value=\"GWOT\" aria-errormessage=\"wpforms-1802-field_2_6-error\" aria-describedby=\"wpforms-1802-field_2-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_2_6\">GWOT<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-1802-field_2_7\" name=\"wpforms[fields][2][]\" value=\"OTHER\" aria-errormessage=\"wpforms-1802-field_2_7-error\" aria-describedby=\"wpforms-1802-field_2-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_2_7\">OTHER<\/label><\/li><\/ul><div id=\"wpforms-1802-field_2-description\" class=\"wpforms-field-description\">Currently, we are only accepting applications for veterans who served during the WWII, Vietnam and Korean war periods. <\/div><\/fieldset><\/div><div id=\"wpforms-1802-field_135-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"135\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1802-field_135\">List other war or conflict you are a veteran of:<\/label><input type=\"text\" id=\"wpforms-1802-field_135\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"1802\" data-field-id=\"135\" data-text-limit=\"120\" name=\"wpforms[fields][135]\" aria-errormessage=\"wpforms-1802-field_135-error\" maxlength=\"120\" ><\/div><div id=\"wpforms-1802-field_7-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-1802-field_7\">What years did you serve? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1802-field_7\" class=\"wpforms-field-small wpforms-field-required wpforms-limit-characters-enabled\" data-form-id=\"1802\" data-field-id=\"7\" data-text-limit=\"100\" name=\"wpforms[fields][7]\" aria-errormessage=\"wpforms-1802-field_7-error\" maxlength=\"100\" required><\/div><div id=\"wpforms-1802-field_10-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"10\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-50\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1802-field_149-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"149\"><label class=\"wpforms-field-label\" for=\"wpforms-1802-field_149\">Branch of Service: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><select id=\"wpforms-1802-field_149\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][149]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Select<\/option><option value=\"U.S. Army\"  class=\"choice-1 depth-1\"  >U.S. Army<\/option><option value=\"U.S. Marine Corps\"  class=\"choice-2 depth-1\"  >U.S. Marine Corps<\/option><option value=\"U.S. Navy\"  class=\"choice-3 depth-1\"  >U.S. Navy<\/option><option value=\"U.S. Air Force\"  class=\"choice-5 depth-1\"  >U.S. Air Force<\/option><option value=\"U.S. Space Force\"  class=\"choice-4 depth-1\"  >U.S. Space Force<\/option><option value=\"U.S. Coast Guard\"  class=\"choice-6 depth-1\"  >U.S. Coast Guard<\/option><\/select><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1802-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-1802-field_9\">Rank: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1802-field_9\" class=\"wpforms-field-small wpforms-field-required\" name=\"wpforms[fields][9]\" aria-errormessage=\"wpforms-1802-field_9-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><\/div><\/div><\/div><div id=\"wpforms-1802-field_12-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"12\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-25-25\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1802-field_11-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"11\"><fieldset><legend class=\"wpforms-field-label\">Birth Date: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][11][date][m]\" id=\"wpforms-1802-field_11-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\" aria-label=\"Month\"  required><option value=\"\" class=\"placeholder\" selected disabled>MM<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][11][date][d]\" id=\"wpforms-1802-field_11-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\" aria-label=\"Day\"  required><option value=\"\" class=\"placeholder\" selected disabled>DD<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][11][date][y]\" id=\"wpforms-1802-field_11-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\" aria-label=\"Year\"  required><option value=\"\" class=\"placeholder\" selected disabled>YYYY<\/option><option value=\"2027\" >2027<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><\/select><\/div><\/fieldset><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1802-field_13-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-1802-field_13\">Age: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1802-field_13\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][13]\" aria-errormessage=\"wpforms-1802-field_13-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1802-field_14-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-1802-field_14\">Nickname: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1802-field_14\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][14]\" aria-errormessage=\"wpforms-1802-field_14-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><\/div><\/div><div id=\"wpforms-1802-field_15-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"15\"><fieldset><legend class=\"wpforms-field-label\">Gender: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1802-field_15\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_15_1\" name=\"wpforms[fields][15]\" value=\"Male\" aria-errormessage=\"wpforms-1802-field_15_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_15_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_15_2\" name=\"wpforms[fields][15]\" value=\"Female\" aria-errormessage=\"wpforms-1802-field_15_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_15_2\">Female<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1802-field_19-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"19\"><fieldset><legend class=\"wpforms-field-label\">Veteran&#039;s Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-1802-field_19\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][19][address1]\" aria-errormessage=\"wpforms-1802-field_19-error\" required><label for=\"wpforms-1802-field_19\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-1802-field_19-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][19][address2]\" aria-errormessage=\"wpforms-1802-field_19-address2-error\" ><label for=\"wpforms-1802-field_19-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1802-field_19-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][19][city]\" aria-errormessage=\"wpforms-1802-field_19-city-error\" required><label for=\"wpforms-1802-field_19-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1802-field_19-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][19][state]\" aria-errormessage=\"wpforms-1802-field_19-state-error\" required><label for=\"wpforms-1802-field_19-state\" class=\"wpforms-field-sublabel after\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1802-field_19-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][19][postal]\" aria-errormessage=\"wpforms-1802-field_19-postal-error\" required><label for=\"wpforms-1802-field_19-postal\" class=\"wpforms-field-sublabel after\">Postal Code<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-1802-field_19-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][19][country]\" value=\"US\" aria-errormessage=\"wpforms-1802-field_19-country-error\" required><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albania<\/option><option value=\"DZ\" >Algeria<\/option><option value=\"AS\" >American Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua and Barbuda<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgium<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia (Plurinational State of)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvet Island<\/option><option value=\"BR\" >Brazil<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\" >Canada<\/option><option value=\"KY\" >Cayman Islands<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocos (Keeling) Islands<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoros<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Democratic Republic of the)<\/option><option value=\"CK\" >Cook Islands<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"CZ\" >Czech Republic<\/option><option value=\"CI\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"DK\" >Denmark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypt<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"SZ\" >Eswatini (Kingdom of)<\/option><option value=\"ET\" >Ethiopia<\/option><option value=\"FK\" >Falkland Islands (Malvinas)<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >France<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"DE\" >Germany<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GR\" >Greece<\/option><option value=\"GL\" >Greenland<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungary<\/option><option value=\"IS\" >Iceland<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran (Islamic Republic of)<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Ireland (Republic of)<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italy<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordan<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"KP\" >Korea (Democratic People&#039;s Republic of)<\/option><option value=\"KR\" >Korea (Republic of)<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Lao People&#039;s Democratic Republic<\/option><option value=\"LV\" >Latvia<\/option><option value=\"LB\" >Lebanon<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libya<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithuania<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia (Federated States of)<\/option><option value=\"MD\" >Moldova (Republic of)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MA\" >Morocco<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NZ\" >New Zealand<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MK\" >North Macedonia (Republic of)<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"NO\" >Norway<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (State of)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Poland<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Romania<\/option><option value=\"RU\" >Russian Federation<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"SH\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tome and Principe<\/option><option value=\"SA\" >Saudi Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (Dutch part)<\/option><option value=\"SK\" >Slovakia<\/option><option value=\"SI\" >Slovenia<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ZA\" >South Africa<\/option><option value=\"GS\" >South Georgia and the South Sandwich Islands<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spain<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"SE\" >Sweden<\/option><option value=\"CH\" >Switzerland<\/option><option value=\"SY\" >Syrian Arab Republic<\/option><option value=\"TW\" >Taiwan, Republic of China<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania (United Republic of)<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad and Tobago<\/option><option value=\"TN\" >Tunisia<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"US\"  selected='selected'>United States of America<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatican City State<\/option><option value=\"VE\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (U.S.)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"AX\" >\u00c5land Islands<\/option><\/select><label for=\"wpforms-1802-field_19-country\" class=\"wpforms-field-sublabel after\">Country<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-1802-field_133-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"133\"><label class=\"wpforms-field-label\" for=\"wpforms-1802-field_133\">County <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1802-field_133\" class=\"wpforms-field-medium wpforms-field-required wpforms-limit-characters-enabled\" data-form-id=\"1802\" data-field-id=\"133\" data-text-limit=\"100\" name=\"wpforms[fields][133]\" aria-errormessage=\"wpforms-1802-field_133-error\" maxlength=\"100\" required><\/div><div id=\"wpforms-1802-field_23-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"23\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-25-25\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1802-field_20-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-1802-field_20\">Veteran&#039;s Phone (Day) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1802-field_20\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][20]\" aria-label=\"Veteran&#039;s Phone (Day)\" aria-errormessage=\"wpforms-1802-field_20-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1802-field_21-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-1802-field_21\">Veteran&#039;s Phone (Evening) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1802-field_21\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][21]\" aria-label=\"Veteran&#039;s Phone (Evening)\" aria-errormessage=\"wpforms-1802-field_21-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1802-field_22-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-1802-field_22\">Veteran&#039;s Phone (Cell)<\/label><input type=\"tel\" id=\"wpforms-1802-field_22\" class=\"wpforms-field-medium wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][22]\" aria-label=\"Veteran&#039;s Phone (Cell)\" aria-errormessage=\"wpforms-1802-field_22-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><\/div><\/div><div id=\"wpforms-1802-field_24-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-1802-field_24\">Email Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1802-field_24\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][24]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1802-field_24-error\" aria-describedby=\"wpforms-1802-field_24-description\" required><div id=\"wpforms-1802-field_24-description\" class=\"wpforms-field-description\">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.<\/div><\/div><div id=\"wpforms-1802-field_136-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"136\"><fieldset><legend class=\"wpforms-field-label\">T-Shirt Size <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1802-field_136\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_136_1\" name=\"wpforms[fields][136]\" value=\"S\" aria-errormessage=\"wpforms-1802-field_136_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_136_1\">S<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_136_2\" name=\"wpforms[fields][136]\" value=\"M\" aria-errormessage=\"wpforms-1802-field_136_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_136_2\">M<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_136_3\" name=\"wpforms[fields][136]\" value=\"L\" aria-errormessage=\"wpforms-1802-field_136_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_136_3\">L<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_136_7\" name=\"wpforms[fields][136]\" value=\"XL\" aria-errormessage=\"wpforms-1802-field_136_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_136_7\">XL<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_136_6\" name=\"wpforms[fields][136]\" value=\"2XL\" aria-errormessage=\"wpforms-1802-field_136_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_136_6\">2XL<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_136_5\" name=\"wpforms[fields][136]\" value=\"3XL\" aria-errormessage=\"wpforms-1802-field_136_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_136_5\">3XL<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_136_4\" name=\"wpforms[fields][136]\" value=\"4XL\" aria-errormessage=\"wpforms-1802-field_136_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_136_4\">4XL<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1802-field_137-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"137\"><fieldset><legend class=\"wpforms-field-label\">Jacket Size <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1802-field_137\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_137_1\" name=\"wpforms[fields][137]\" value=\"S\" aria-errormessage=\"wpforms-1802-field_137_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_137_1\">S<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_137_2\" name=\"wpforms[fields][137]\" value=\"M\" aria-errormessage=\"wpforms-1802-field_137_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_137_2\">M<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_137_3\" name=\"wpforms[fields][137]\" value=\"L\" aria-errormessage=\"wpforms-1802-field_137_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_137_3\">L<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_137_7\" name=\"wpforms[fields][137]\" value=\"XL\" aria-errormessage=\"wpforms-1802-field_137_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_137_7\">XL<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_137_6\" name=\"wpforms[fields][137]\" value=\"2XL\" aria-errormessage=\"wpforms-1802-field_137_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_137_6\">2XL<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_137_5\" name=\"wpforms[fields][137]\" value=\"3XL\" aria-errormessage=\"wpforms-1802-field_137_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_137_5\">3XL<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_137_4\" name=\"wpforms[fields][137]\" value=\"4XL\" aria-errormessage=\"wpforms-1802-field_137_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_137_4\">4XL<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1802-field_74-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"74\"><fieldset><legend class=\"wpforms-field-label\">Do you have a TERMINAL ILLNESS? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1802-field_74\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_74_1\" name=\"wpforms[fields][74]\" value=\"Yes\" aria-errormessage=\"wpforms-1802-field_74_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_74_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1802-field_74_2\" name=\"wpforms[fields][74]\" value=\"No\" aria-errormessage=\"wpforms-1802-field_74_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1802-field_74_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1802-field_75-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"textarea\" data-field-id=\"75\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-1802-field_75\">Describe your terminal Illness: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-1802-field_75\" class=\"wpforms-field-medium wpforms-field-required wpforms-limit-characters-enabled\" data-form-id=\"1802\" data-field-id=\"75\" data-text-limit=\"4000\" name=\"wpforms[fields][75]\" aria-errormessage=\"wpforms-1802-field_75-error\" maxlength=\"4000\" required><\/textarea><\/div><div id=\"wpforms-1802-field_138-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"138\"><label class=\"wpforms-field-label\" for=\"wpforms-1802-field_138\">Is there another Honor Flight Veteran that you would like to be on this flight with you? If so, who?<\/label><input type=\"text\" id=\"wpforms-1802-field_138\" class=\"wpforms-field-large wpforms-limit-characters-enabled\" data-form-id=\"1802\" data-field-id=\"138\" data-text-limit=\"150\" name=\"wpforms[fields][138]\" aria-errormessage=\"wpforms-1802-field_138-error\" maxlength=\"150\" ><\/div><div id=\"wpforms-1802-field_140-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"140\"><div id=\"wpforms-1802-field_140\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-1802-field_140-error\"><h4>ALTERNATE CONTACT INFORMATION<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-1802-field_139-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"139\"><fieldset><legend class=\"wpforms-field-label\">Alternate Contact Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-1802-field_139\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][139][first]\" aria-errormessage=\"wpforms-1802-field_139-error\" required><label for=\"wpforms-1802-field_139\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1802-field_139-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][139][last]\" aria-errormessage=\"wpforms-1802-field_139-last-error\" required><label for=\"wpforms-1802-field_139-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-1802-field_141-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"141\"><label class=\"wpforms-field-label\" for=\"wpforms-1802-field_141\">Relationship <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1802-field_141\" class=\"wpforms-field-medium wpforms-field-required wpforms-limit-characters-enabled\" data-form-id=\"1802\" data-field-id=\"141\" data-text-limit=\"100\" name=\"wpforms[fields][141]\" aria-errormessage=\"wpforms-1802-field_141-error\" maxlength=\"100\" required><\/div><div id=\"wpforms-1802-field_142-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"142\"><fieldset><legend class=\"wpforms-field-label\">Alternate Contact Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-1802-field_142\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][142][address1]\" aria-errormessage=\"wpforms-1802-field_142-error\" required><label for=\"wpforms-1802-field_142\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-1802-field_142-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][142][address2]\" aria-errormessage=\"wpforms-1802-field_142-address2-error\" ><label for=\"wpforms-1802-field_142-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1802-field_142-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][142][city]\" aria-errormessage=\"wpforms-1802-field_142-city-error\" required><label for=\"wpforms-1802-field_142-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1802-field_142-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][142][state]\" aria-errormessage=\"wpforms-1802-field_142-state-error\" required><label for=\"wpforms-1802-field_142-state\" class=\"wpforms-field-sublabel after\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-1802-field_142-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][142][postal]\" aria-errormessage=\"wpforms-1802-field_142-postal-error\" required><label for=\"wpforms-1802-field_142-postal\" class=\"wpforms-field-sublabel after\">Postal Code<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-1802-field_142-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][142][country]\" value=\"US\" aria-errormessage=\"wpforms-1802-field_142-country-error\" required><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albania<\/option><option value=\"DZ\" >Algeria<\/option><option value=\"AS\" >American Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua and Barbuda<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgium<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia (Plurinational State of)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvet Island<\/option><option value=\"BR\" >Brazil<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\" >Canada<\/option><option value=\"KY\" >Cayman Islands<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocos (Keeling) Islands<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoros<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Democratic Republic of the)<\/option><option value=\"CK\" >Cook Islands<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"CZ\" >Czech Republic<\/option><option value=\"CI\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"DK\" >Denmark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypt<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"SZ\" >Eswatini (Kingdom of)<\/option><option value=\"ET\" >Ethiopia<\/option><option value=\"FK\" >Falkland Islands (Malvinas)<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >France<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"DE\" >Germany<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GR\" >Greece<\/option><option value=\"GL\" >Greenland<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungary<\/option><option value=\"IS\" >Iceland<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran (Islamic Republic of)<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Ireland (Republic of)<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italy<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordan<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"KP\" >Korea (Democratic People&#039;s Republic of)<\/option><option value=\"KR\" >Korea (Republic of)<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Lao People&#039;s Democratic Republic<\/option><option value=\"LV\" >Latvia<\/option><option value=\"LB\" >Lebanon<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libya<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithuania<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia (Federated States of)<\/option><option value=\"MD\" >Moldova (Republic of)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MA\" >Morocco<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NZ\" >New Zealand<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MK\" >North Macedonia (Republic of)<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"NO\" >Norway<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (State of)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Poland<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Romania<\/option><option value=\"RU\" >Russian Federation<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"SH\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tome and Principe<\/option><option value=\"SA\" >Saudi Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (Dutch part)<\/option><option value=\"SK\" >Slovakia<\/option><option value=\"SI\" >Slovenia<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ZA\" >South Africa<\/option><option value=\"GS\" >South Georgia and the South Sandwich Islands<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spain<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"SE\" >Sweden<\/option><option value=\"CH\" >Switzerland<\/option><option value=\"SY\" >Syrian Arab Republic<\/option><option value=\"TW\" >Taiwan, Republic of China<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania (United Republic of)<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad and Tobago<\/option><option value=\"TN\" >Tunisia<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"US\"  selected='selected'>United States of America<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatican City State<\/option><option value=\"VE\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (U.S.)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"AX\" >\u00c5land Islands<\/option><\/select><label for=\"wpforms-1802-field_142-country\" class=\"wpforms-field-sublabel after\">Country<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-1802-field_143-container\" class=\"wpforms-field wpforms-field-layout\" data-field-type=\"layout\" data-field-id=\"143\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-25-25-25-25\"><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1802-field_144-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"144\"><label class=\"wpforms-field-label\" for=\"wpforms-1802-field_144\">Contact&#039;s Phone (Day) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1802-field_144\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][144]\" aria-label=\"Contact&#039;s Phone (Day)\" aria-errormessage=\"wpforms-1802-field_144-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1802-field_145-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"145\"><label class=\"wpforms-field-label\" for=\"wpforms-1802-field_145\">Contact&#039;s Phone (Evening) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-1802-field_145\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][145]\" aria-label=\"Contact&#039;s Phone (Evening)\" aria-errormessage=\"wpforms-1802-field_145-error\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><div id=\"wpforms-1802-field_146-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"146\"><label class=\"wpforms-field-label\" for=\"wpforms-1802-field_146\">Contact&#039;s Phone (Cell)<\/label><input type=\"tel\" id=\"wpforms-1802-field_146\" class=\"wpforms-field-medium wpforms-masked-input\" data-inputmask=\"&#039;mask&#039;: &#039;(999) 999-9999&#039;\" data-rule-us-phone-field=\"true\" data-inputmask-inputmode=\"tel\" name=\"wpforms[fields][146]\" aria-label=\"Contact&#039;s Phone (Cell)\" aria-errormessage=\"wpforms-1802-field_146-error\" ><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-25\" ><\/div><\/div><\/div><div id=\"wpforms-1802-field_147-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"147\"><label class=\"wpforms-field-label\" for=\"wpforms-1802-field_147\">Alternate Contact&#039;s Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1802-field_147\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][147]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1802-field_147-error\" required><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"1802\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/westernndhf.org\/index.php?rest_route=\/wp\/v2\/pages\/505\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1802\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" src=\"https:\/\/westernndhf.org\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. Veteran&#039;s Name * FirstMiddleLastAS 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<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":499,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-fullwidth.php","meta":{"_coblocks_attr":"","_coblocks_dimensions":"","_coblocks_responsive_height":"","_coblocks_accordion_ie_support":"","_mc_calendar":[],"footnotes":""},"class_list":["post-505","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/westernndhf.org\/index.php?rest_route=\/wp\/v2\/pages\/505","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/westernndhf.org\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/westernndhf.org\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/westernndhf.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/westernndhf.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=505"}],"version-history":[{"count":13,"href":"https:\/\/westernndhf.org\/index.php?rest_route=\/wp\/v2\/pages\/505\/revisions"}],"predecessor-version":[{"id":2496,"href":"https:\/\/westernndhf.org\/index.php?rest_route=\/wp\/v2\/pages\/505\/revisions\/2496"}],"up":[{"embeddable":true,"href":"https:\/\/westernndhf.org\/index.php?rest_route=\/wp\/v2\/pages\/499"}],"wp:attachment":[{"href":"https:\/\/westernndhf.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=505"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}