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Vietnam Veteran Fishing Adventure

First Name(required)

Last Name(required)

Street Address(required)

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Zip(required)

Email(required)

Phone Number(required)

Gender

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T-Shirt Size

Military Information

Branch of Service(required)

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How long did you serve in the armed forces?

Job Title

Rank upon separation

Honorable Discharge?(required)

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Units served with:

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Please tell us about yourself:

Do you require any special accommodations?

Are you currently under investigation or criminal proceedings for any firearms violations from any state or federal entity?(required)

If Yes, please explain:

Are you currently prohibited from owning or using a firearm due to criminal prosecution?(required)

If Yes, please explain:

Do you consume alcohol?

Do you have any concerns being around alcohol?

Emergency Contact

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Almost Done!

u003cstrongu003eAUTHORIZATION: By selecting u0022Yesu0022 below and submitting this application, I authorize the verification of the information on this form as to my military service and allow Brady Oberg Legacy Foundation to contact me at the address and phone number provided:u003c/strongu003e(required)

Yes No

u003cstrongu003eu003cstrongu003eAre you currently serving in the militaryu003c/strongu003eu003c/strongu003e?(required)

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If no, please email a copy of your DD214 to: oberglegacy@gmail.com.

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Thank you for your interest in the Brady Oberg Legacy Foundation. We thank you for your service!

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