Veterans Camp Registration Pt 2
Step 1 of 2: Submit
Full Name
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Next of Kin
NOK Name:
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NOK Contact Number
*
NOK - Relationship to you
*
Service
Surname if different when serving
Rank at end of Service
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Who did you Serve With
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Select an option:
Army
Navy
Air Force
Merchant Navy
Which Corps, Regiment, Ship, Squadron etc did you serve with?
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Date of Enlistment
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Date of Discharge
*
Did you serve in any operational areas?
Injuries and Illnesses
Can you please tell us whether there are any other medical conditions, illnesses or injuries we should be aware of that you have NOT already declared to us
Are you currently engaged with any medical or health professionals?
Declaration
By signing this form, I confirm the information I've given is true and correct. I understand Outpost Charity will process my data & protect it in accordance with General Data Protection Regulations and that Outpost Charity will not share my information with any third party without my explicit consent.
Signed
*
Date:
Saturday, 10 June 2023 (EDT)
Name:
Type your name to sign this document:
Typing name is equivalent to a handwritten signature
OFFICE USE ONLY: AD STAT
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indicates required fields