Fill out and submit this form to register for any course listed in "Course/Date" below.
For specific date details, see the calendar or click on More Info on a specific item below. |
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Course/Date*
Please select all
courses/events you wish
to attend; if you are
considering multiple
dates for a course, select
each consideration.
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Course/Event |
Location |
Specifics |
Start Date |
Cost |
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Vets Journey Home | Houston TX | March 2012 | March 16, 2012 | 0.00 | More Info  |
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Vets Journey Home | Post 1318 Madison, WI | April 2012 | April 13, 2012 | 0.00 | More Info |
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Vets Journey Home | Gaia Healing Ctr Mount Airy MD | April 2012 | April 20, 2012 | 0.00 | More Info |
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Vets Journey Home | Camp Bird, Crivitz WI | May 2012 | May 18, 2012 | 0.00 | More Info |
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Vets Journey Home | Houston TX | June 2012 | June 22, 2012 | 0.00 | More Info |
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Vets Journey Home | Houston TX | July 2012 Couples Retreat | July 27, 2012 | 0.00 | More Info |
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Vets Journey Home | Milwaukee, WI | August 2012 | August 17, 2012 | 0.00 | More Info |
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Vets Journey Home/CAL | Lake Tomahawk, WI | September 2012 | September 17, 2012 | 0.00 | More Info |
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Vets Journey Home | Houston TX | October 2012 | October 19, 2012 | 0.00 | More Info |
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Vets Journey Home | Santa Barbara, CA | October 2012 | October 19, 2012 | 0.00 | More Info |
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| Will you be a participant or staff member?* |
if staff, are you a veteran or civilian?
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| Gender* |
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| First Name* |
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| Last Name* |
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| Email |
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| Occupation |
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| Birth Date |
(format m/d/yyyy) |
| Street Address |
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| City |
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| State |
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| Zip |
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| Home Phone** |
(format 123-456-7890) |
| Cell Phone** |
(format 123-456-7890) |
| Work Phone** |
(format 123-456-7890) |
| Who referred you to us? |
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| If registering as a Participant, please give us information about your service and goals |
| Branch |
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| MOS |
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| Have you served in Combat? |
if yes, theater of action: |
| Dates of service |
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What is the outcome you would
like for yourself from attending
this program? |
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| Other comments |
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Are you a human?*
(This helps us prevent
spam and bots)
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*Required
**At least one telephone number is required |