Name: 2023: Middle East Conflicts Wall Memorial
Start: 2023-08-25T07:00:00-05:00
End: 2023-08-27T17:00:00-05:00

Name*

First Last

* Exactly as it appears on your Government Issued ID

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Date of Birth*

Used for booking flights and to verify age of 18+

Shirt Size*

Height*

*Used to reserve correct gear

Weight*

*Used to reserve correct gear

Military Branch*

Highest Rank Achieved*

*(i.e. “SSG” or “Staff Sergeant”)

Middle East Conflict Deployment (required)*

Iraq
Afghanistan
Desert Storm
Somalia
Kuwait
Syria
Libya
Yemen
Other (please specify below)

Means of Transportation

I plan to ride in Passenger Van (costs covered)
I plan to ride my motorcycle (gas not covered)

*We will all move north together as one unit. (Each Way = 485 Miles / 8 Hours)

My DD-214 can confirm both an Honorable Discharge and Middle East Combat Deployment

Yes, I’ve been Honorably Discharged and have deployed to the Middle East

*Required for the Middle East Conflicts Wall Memorial trip

ALLERGIES?

PLEASE SPECIFY IN DETAIL! Example: Allergic to Onions, Dog Allergy, Bee Allergy, Peanut, etc.

Room Sharing

I’m willing to share a room (same sex)
Please consider a private room for me*

*Sharing a room enables us to include more veterans on our trips. Selecting private room is not a guarantee as our priority is to maximize the number of veterans on each trip due to our growing waiting list.

Injuries, Limitations, Special Conditions:*

* Type “none” if not applicable

Please tell us a little about yourself:*

How did you hear about Waypoint Vets?*

EMERGENCY CONTACT:*

First Last

Emergency Contact Phone:*

Emergency Contact Email:*

Relationship:*

Emergency Contact Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

* Not Required

Consent / Waiver / Signature*

My information is true and correct, and I consent to the following policy, waiver, release, and acknowledgement.

I hereby certify that the above information is true and correct to the best of my knowledge. I understand that the information or documentation I have provided is confidential and will not be shared with anyone outside of the Waypoint Vets Team.

I hereby certify that I am a Combat Veteran of a Middle East Conflict and have been Honorably Discharged from the United States Military.

I understand that this is a substance free / “dry” experience, and will respect and adhere to this guideline out of respect for my fellow veterans and the staff and support involved with making this experience possible.

I understand that a prescription or doctor’s note will be required for the use of medicinal marijuana, and that use is still contingent upon the laws of the states we’ll be traveling from, to, AND through.

Photos and video may be taken and used to memorialize the trip. I grant permission for this media to be used or published to advance and promote the missions of Waypoint Vets, Warrior Project, the VFW, and VFW Post 9851. I waive ownership and compensation for use of these materials.

I understand that my medical insurance is my responsibility and that Waypoint Vets, Warrior Project, VFW Post 9851 and its owners, agents, officers, employees, and volunteers do not provide medical care or compensation. I accept all risks associated with travel and other activities and will not hold Waypoint Vets, Warrior Project, or VFW Post 9851 or its owners, agents, officers, employees, or volunteers responsible for any injury or loss I may suffer while participating in the Middle East Conflicts Wall Memorial trip.

6. I understand that I’m participating in the Waypoint Retreat at my own free will. I acknowledge that by participating in the retreat I am not entering into a therapeutic relationship with any staff associated with the event or Waypoint Vets. I understand I am waiving any liability of any staff for any psychological or emotional stress that may arise through the course of the event. Intentionally or unintentionally I am aware that stressful emotions may arise during the event and it is my responsibility to seek professional services outside of the retreat if the need arises.

7. Participant authorizes WAYPOINT VETS and/or its authorized personnel to call for medical care for him/her or to transport him/her to a medical facility or hospital if, in the opinion of such personnel, medical attention is needed for him/ her. Participant agrees that upon his/her
transport to any such medical facility or hospital that WAYPOINT VETS shall not have any further responsibility for him/her. Further, Participant agrees to pay all costs associated with such medical care and related transportation provided for him/her and shall indemnify and hold harmless WAYPOINT VETS of and from any costs incurred therein.

I will not bring, use, purchase, or obtain firearms of illegal substances while on this trip.

Checking this box and clicking Submit acts as a digital signature, agreeing to our waiver and terms for the Middle East Conflicts Wall Memorial Trip.

August 25, 2023 @ 7:00 am – August 27, 2023 @ 5:00 pm CDT

Middle East Conflicts Wall Application

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2023: Middle East Conflicts Wall Memorial

August 25, 2023 @ 7:00 am – August 27, 2023 @ 5:00 pm CDT

Middle East Conflicts Wall Application

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