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Event Form

Vietnam Veteran Fishing Adventure

First Name(required)

Last Name(required)

Street Address(required)

City(required)

State(required)

Zip(required)

Email(required)

Phone Number(required)

Gender

Male Female

T-Shirt Size

Military Information

Branch of Service(required)

Army Navy Marines Air Force Coast Guard National Guard Reserves

How long did you serve in the armed forces?

Job Title

Rank upon separation

Honorable Discharge?(required)

Yes No

Units served with:

Other

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

First Name(required)

Last Name(required)

Street Address(required)

City(required)

State(required)

Zip(required)

Relationship(required)

Phone Number(required)

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)

Yes No

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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