Honor Flight Tri-State: Veterans Application

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Flight Schedule

Our next scheduled* flights are:
May 01, 2012
June 12, 2012
August 14, 2012
September 25, 2012
October 30, 2012

*All dates tentative

Form:	Veteran Application
Honor Flight recognizes American Veterans for your sacrifices and accomplishments by flying you to Washington, DC to visit your memorial at no cost. We are accepting applications from all war veterans, but are giving priority to WWII veterans. Terminally ill veterans get priority on all flights. We are now accepting Korean war veterans with no flight date guaranteed. It is our goal to provide you with a safe, memorable, and rewarding experience. To help us do that, we will provide Guardians to assist you with any and all of your needs throughout the day, and to provide you with a Flight with Honor. The information contained on this application is for the use of Honor Flight Tri- State only and will not be shared with anyone. If you have questions, please call us on our hotline - 513-277-9626.

Personal Information
Name First Middle Last	(As it appears on your photo ID for airline travel)
Date of Birth	Gender
Address
(if needed) Address 2
City,State,Zip	,
Daytime Phone
Nightime Phone
Cell Phone
Email
T-Shirt size	Weight Age

Service History
Branch of Service	War
Activity during service
Discharged date
How did you hear about us?

Medical Information
Would you like us to have a wheelchair available for your use?
Are you Diabetic? If yes, do you require insulin injections?
Do you have a history of seizure?
Do you use oxygen at any time during the day?
Do you have a draining catheter or colostomy bag?
Do you have any problems flying in a commercial aircraft?
Are you able to walk up and down four steps on a tour bus?
Do you have a feeding tube of any type?
Any other medical information that we should know about? Please explain

Do you have a specific person that you would like to have as your Guardian?
If Yes, Name Relationship Age
Disclaimer I, the undersigned, acknowledge and agree that: 1. As photographic and video equipment are frequently used to memorialize and document Honor Flight Tri-State trips and events, my image may appear in a public forum, such as the news media or a website, to acknowledge or promote the work of the Honor Flight Tri-State Program. I hereby release the photographer and Honor Flight Tri-State from all claims and liability relating to said photographs. I hereby give my permission for my image captured during the Honor Flight Tri-State Activities through video, photos or other media, to be used solely for the purposes of Honor Flight promotional materials and publications, and waive any rights, compensation or ownership thereto. 2.I further understand that medical and trip insurance is the responsibility of the veteran. I also understand and agree that Honor Flight Tri-State does not provide medical care. I understand that I accept all risks associated with air and ground travel, and other Honor Flight Tri-State Activities and will not hold Honor Flight Tri-State responsible for any injuries incurred by me while participating in the Honor Flight Tri-State Program.
I agree to the above	(you may have to sign a release before the flight)
Date