Fireworks Course Registration
Instructions:
To reserve your seat please complete this form with a copy of your DD-214. Upon completion you will receive an email with address to class.
VETERAN'S INFORMATION
Name of Veteran (First, M.I., Last)
Address Line 1
Address Line 2
City
State
Zip Code
Phone
Email
Military Branch
Years of Service
Combat Veteran:
Yes
No
Upload Copy of DD-214, Veteran Designated Driver's License or VA Card
Relevant Medical Conditions
Accommodations Needed
SUPPORT SYSTEM'S INFORMATION
Name (First, M.I., Last)
Are you a Veteran?
Yes
No
Address Line 1
Address Line 2
City
State
Zip Code
Phone
Email
Please List Children or Other Family / Support Team Members That Plan to Attend
Child Care Requested
Comments
Disclaimer
: Fidelis Family Retreat Inc., will not share your information to any third parties. It will be used for internal use only.
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