Veterans Legacy Event Registration Form

Veterans Legacy Event Registration Form
Join us on Saturday, December 6th, from 10:00 am - 1:00 pm at the Legends Center located at 5130 Soutel Drive for a supportive and informative event dedicated to honoring the legacy of veterans by empowering their surviving spouses, families, and caregivers. This gathering will provide guidance, resources, and one-on-one assistance to help you navigate the benefits and support available to you.
Name*

First NameLast Name
Email (for reminder purposes)
example@example.com
Phone Number
Please enter a valid phone number.
Please choose the option that best describes you.*

Female VeteranMale VeteranSurviving SpouseLiving SpouseCaregiverDependent (age 18-23)Other
What type of support are you looking for?*

DIC (Dependency and Indemnity Compensation)Surviving Spouse BenefitsHelp Completing ClaimsHelp with PACT ACT ClaimsCaregiver BenefitsAid & AttendanceVA Nursing Home OptionsResources from Community ProvidersOther
How did you hear about this event?*

Social MediaSearch Engine (Google, Yahoo, Bing, etc.)Monthly NewsletterReferral from an organizationOnline AdPrint AdAttending previous eventsOther
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