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To submit a request to participate in the Veteran of the Game program, please fill in the following information.

First Name

Last Name

Pronunciation

Current Mailing Address

City

State

Zip Code

Home Number

Cell Number

Hometown

Choice of Team

Would You Like to be Honored Virtually, In Person Or In Memoriam?

Virtually In Person In Memoriam

Status

Branch of Service

Rank

Era Served In

Date of Military Service Beginning

Date of Discharge (If Applicable)

Do you have an Honorable Discharge

Yes No

Military Awards and Decorations

Are You Receiving Department of Veterans Service Connection Disability Pay?

Yes No

What Percentage Are You Currently Receiving?

Would you be interested in a complementary review and counsel of your VA Compensation by a Professional Legal Team?

Yes No

Submit A Minimum of Two Photos Of The Veteran While They Were In Service

DD214 / Discharge Papers (If Applicable)

Covid Vaccination