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Name (required Field): *

Email address (Required Field):

Cell Telephone (Required Field): *

Grade/Rank (Reqired Field):

Retired Military (Required Field):

Yes
No

Branch of Service (Required Field):

Air Force
Army
Coast Guard
Marines
National Guard
Navy
Space Force

Birth Day (Month/Day) (Required Field): *

Do you belong to a Veterans Organization(s)?

Yes
No

If yes, check the appropriate box(es) for the Veterans Organization(s) you belong to:

The American Legion (AL)
American Veterans (AMVETS)
Blinded Veterans Association (BVA)
Disabled American Veterans (DVA)
Paralyzed Veterans of America (PVA)
Veterans of Foreign Wars (VFW)
Vets in the Know Connect Group
Vietnam Veterans of America, Inc
Other (Explain in column below):

Are you receiving or have you applied for your VA benefits? (Required Field)

Yes
No

If no, do you require help in locating a Veterans Service Organization (VSO) or Veterans Service Group (VSG) representative to assist you? (Required Field)

Yes
No

Are you a member of Linked Up Church? (Required Field)

Yes
No

Release of Information: “I consent to the release of my cell phone number and email address to other members of the “Vets in the Know” Connect Group.” *Required Field)

Yes
No

Signature and Date (Type): *

Leave this field empty