testing – initial contact form

Would you, or someone you know be interested in learning more about CWVC? Please submit the initial contact form below.
 

    Basic Information

    Name: (as appears on Driver’s License)

    Date of Birth

    Branch of Service

    Rank

    Status: Active or Retired (comments if warranted)
    ActiveRetired
    Comments:

    Mailing Address

    City

    State

    Zip Code

    Phone

    Primary Email

    Secondary Email

    Is there a particular challenge, or type of challenge (SCUBA, Mountaineering, etc.) you are interested in participating in?
    SCUBAMountaineeringSailingKayakingAllOther

    If "other" please enter challenge type here:

    The above will be used only to ascertain initial interest; your privacy will be respected regarding any information disclosed to CWVC. For some Challenges, immediate family members only (spouse, children) may accompany their combat wounded/injured veteran. If selected to participate, do you anticipate bringing family members (needed for billeting purposes)? Please list family members below (include name, age, and any special needs).

    Thank you for your interest in Combat Wounded Veteran Challenge!