VHF Veteran Online Application

VHF VETERAN APPLICATION
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All Fields marked with Red Asterisk * are mandatory.
Date Submitted

MonthDayYear
Villages Honor Flight, Inc. recognizes American Veterans for their sacrifices and achievements by taking them to Washington, D.C. to see their memorials at no cost. Top priority is given to WWII and terminally ill Veterans from all war eras.

Appplicants for Honor Flight to Washington D.C. must be 75 years of age or above at time of application.

Villages Honor Flight, Inc. also recognizes there are Veterans with physical limitations or who simply prefer not to fly so we offer a 'Flightless' Honor Flight alternative. Our 'Flightless' Honor Flight mirrors and matches the Washington D.C. Flight experience without the need to fly or endure the long day required for a Washington D.C. Honor Flight.

For both Washington D.C. and 'Flightless' Honor Flight missions, volunteer Guardians will go along providing assistance and helping Veterans have a safe, memorable and rewarding experience. Please note, Villages Honor Flight does not accept Veteran-specific requests for Guardians (this includes family members as well). There is no minimum age requirement for 'Flightless' Honor Flight.

For what you and your comrades have given to us, please consider this a small token of appreciation from Villages Honor Flight, Inc. The name and date of birth provided on this application must match the TSA-approved photo ID you will use on Flight Day.

For further information, please contact our Veteran Coordinator:
Email: veterancoordinator@villageshonorflight.org
Visit Website: https://villageshonorflight.org
MUST be a Resident of one of the following Central Florida Counties. Please Select Your County:*

CitrusHernandoLakeMarionSumter
I am applying for the following type of Honor Flight:*

I acknowledge I am 75 or older and want to go on an Honor Flight Mission to Washington D.C.I am applying for 'Flightless' Honor Flight.
Nickname (How you prefer to be addressed).
Name as it appears on photo ID (for TSA purposes)*

First NameMiddle NameLast NameSuffix
Date of Birth*

MonthDayYear
Enter Date of Birth
Date of Birth*

MonthDayYear
MUST BE 75 YEARS OF AGE OR ABOVE
Gender*
Select
Select Height:*
Select Height
Weight:*
(in pounds)
Address*

Street Address

CityState

Zip Code
Daytime Phone Number*

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Email
example@example.com
Branch of Service:*
Select Branch
Rank Upon Discharge:*
When did you Serve?*
Home Town (when you entered the Service)*
City & State
Activity during service period.*
TSA Approved Photo ID Type*
Enter TSA Approved ID Type
State
Enter TSA ID Issuing State if Applicable
Expiration Date

MonthDayYear
Expiration Date of TSA ID if Applicable
EMERGENCY CONTACTS
1st Emergency Contact Name:*

First NameLast Name
Relationship:*
1st Emergency Contact Phone Number*

Area CodePhone Number
1st Emergency Contact Address*

Street Address

Street Address Line 2

CityState

Zip Code
Alternate Emergency Contact Name*

First NameLast Name
Relationship:*
Alternate Emergency Contact Phone Number*

Area CodePhone Number
Alternate Emergency Contact Address

Street Address

Street Address Line 2

CityState

Zip Code
VHF Shirt Style:*
Shirt Size:*

SmallMediumLargeX LargeXX LargeXXX LargeOther
Veterans are permitted to take part in one (1) Honor Flight to help us make sure all Veterans have an opportunity to take part in the program. Please acknowledge your understanding.*

I have NOT been on an Honor Flight.
How did you hear about Honor Flight?
MEDICAL INFORMATION

Information provided will not disqualify you. It permits us to assess the support we need during the trip. Information is for Villages Honor Flight Medical Personnel only.

*DISCLAIMER: Wheelchairs with 250 lb. maximum weight limit are provided for each Veteran and may be required during certain portions of the Honor Flight trip.
Do you use MOBILITY EQUIPMENT? *

CaneWalkerWheelchair*ScooterNot NeededOther
Do you have any breathing problems?*

YesNo
Describe type of breathing problems.
Do you use a home nebulizer machine?

YesNo
If you use a home nebulizer machine you are STRONGLY encouraged to discuss the trip with your private physician concerning the use of portable hand-held nebulizers during the trip.
Do you use oxygen at any time? *

YesNo
If you use oxygen you will be required to provide your own airline approved POC (personal oxygen concentrator) and your physician will need to write a prescription for the oxygen to be used during the flight and tour which should be turned in with your application. Oxygen will not be provided by Honor Flight and liquid oxygen is strictly prohibited for use on airplanes.
What is the delivery rate?
LPM
BRAND NAME OF POC
Can you climb 6 steps onto a bus and walk down the aisle of a bus or plane?*

YesNo
Additional Comments or Concerns:
Typing your name below constitutes your digital signature when sending via email.
Signature*
Please type your name
When completed, select PRINT FORM for your own records and then select SUBMIT,

OR if you encounter problems mail a copy of the printed form to:

Villages Honor Flight, Inc.
Attn: Veteran Application
PO Box 490
Lady Lake, FL 32158-0490
Should be Empty:

VHF VETERAN APPLICATION

EMERGENCY CONTACTS