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Project SOAR Registration

Please complete all of the following questions below ...

Participant First Name *

Participant Last Name *

Address 1 *

Address 2

City *

State *

Zip *

Gender *

Birth Date *

// (mm/dd/yyyy)

Participant Primary Number *

Participant Email *

I am an. . . *

I am an Active Duty Servicemember or Veteran of The. . . *

I am interested in the following Sports and Programs:

Archery
Cycling
Golf
Kayaking
Surfing
Scuba
Yoga
Air Riflery
Equine Assisted Therapy
Sailing
Walking
Equipment Loan Program

Project SOAR T-shirt Size *

Primary Diagnosis *

Disability Rating Percentage *

By initialing below, I certify that I am NOT barred from receiving VA benefits based on my service, including receiving VA pension, compensation, or dependency and indemnity compensation based on the character of my discharge from military services.

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Project SOAR Registration