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Registration Military Veteran
Registration Form
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First Name
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ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST
ARMED FORCES AMERICA (EXCEPT CANADA)
ARMED FORCES PACIFIC
Phone (xxx-xxx-xxxx)
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In which branch of the military did you serve?
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Are you a combat veteran?
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Are you a purple heart recipient?
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No
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Did you receive an Honorable Discharge?
*
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No
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What is your combined VA disability rating?
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Service Start Date (MM/DD/YYYY)
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Service End Date (MM/DD/YYYY)
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How did you hear about the Kentucky Wounded Heroes?
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If you are a military veteran, please redact your SSN and upload a copy of your DD-214
*
DD-214
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If you are a military veteran with a documented disability, please redact your SSN and upload one supporting document.
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Supporting Document
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