If you would like access to OCB's Facility you must fill out this form. This form must be filled out in person at an OCB Facility witnessed by an OCB representative.
Name
*
First Name
Last Name
Suffix
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
OCB Location
*
Indiana-01
Alabama-01
California-01
Reason for visit
*
I am a Veteran
I am Visitor
I am a Volunteer
Age group
*
18 - 24
25 - 39
40 - 55
56 - 70
70+
Branch of Service
*
Army
USMC
Air Force
Navy
Coast Guard
Space Force
N/A
Other
Wartime Service?
*
Yes
No
Peacetime Service?
*
Yes
No
Combat Award?
*
Yes
No
Service Connected Disability?
*
Yes
No
In case of an emergency, please call
*
First Name
Last Name
Emergency Contact Phone Number
*
-
Area Code
Phone Number
I HAVE READ THIS DOCUMENT AND UNDERSTAND IT. I FURTHER UNDERSTAND THAT BY SIGNING THIS RELEASE, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.
*
YES
OCB regularly takes pictures during shop day and at events. Do you grant us permission to use your likeness on OCB digital and print media?
*
YES
I, the [applicant, requestor, etc.] for this [type of form], warrant the truthfulness of the information provided in this application.
*
YES
OCB'S SHOP STANDARD OPERATING PROCEDURES HAVE BEEN EXPLAINED TO ME
*
YES
Last 4 of your SSN
*
Signature
*
Witness
*
First Name
Last Name
Please verify that you are human
*
Submit
Print Form
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