P.O. Box 1373 Heyburn Idaho, 83336, United States
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Outdoor Salute To Veterans
Veterans Application for Events
First Name _____________________ Last ____________________ Middle Initial ____________
Address __________________________________
City ____________________ State _______________ Zip _____________
Home Phone (__ )_______________ Cell ( )_____________________
Emergency Contact ____________________________ Phone _________________________
Which branch of service were you in? Air Force______ Army______ Marines ______ Navy_______ Coast Guard______ How many years did you serve? ________________
When were you discharged Month_______/Year _______
Type of discharge: Honorable _____Less than honorable _____ Dishonorable _____General ______
Percent of disability ____________ What is your disability? ___________________________
If you struggle with PTSD what are your triggers? __________________________________________
So we may better accommodate you, do you have any medical restrictions? Yes_______ No_________
If yes, please explain: ___________________________________________________________________
_____________________________________________________________________________________
Are you diabetic? Yes_____ No_____ Are you allergic to Tylenol, Aspirin, Ibuprofen Yes_____ No_____
Are you allergic to any foods/medications? Yes______ No______
If yes, please list _______________________________________________________________________
In the event of an emergency please list the medications you are currently taking (including herbal regimens and/or vitamins): __________________________________________________________________________________________________________________________________________________________________________
Which event are you applying for: Elk hunt_______ Deer hunt _______ Rafting ______ Camping ______
Steelhead fishing ________ Bass fishing _______ Snowmobiling __________
If you are applying for a hunt would you prefer Rifle_________ Archery _________
If you are applying for a hunt, is there any reason you cannot carry a firearm? Yes_______ No_______
If you do not have a rifle one will be provided for you: Yes, I have a rifle _______ No I need to borrow a rifle _____
What do you plan on taking away from this experience? _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
How do you feel this experience will help you overcome obstacles in your life? _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
How do You feel you can help other veterans? _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
What concerns if any do you have, about your ability to complete the event you are applying for? _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Sign_____________________________________ Date_____________________
Please attach a copy of your Form DD214 and a copy of your Awards Letter from The Department of Veterans Affairs.
If you have any questions, please contact Mark Yearsley (Executive Director) at (208) 404-3559 or email at 2myearsley@gmail.com
Mail this Application, DD214, and Awards letter to the following address;
Outdoor Salute To Veterans
P.O. Box 1373
Heyburn. Idaho 83336
We thank you for your service and sacrifices that you and your family have made on the behalf of us and our fine country!