Efficient Roll Call Application

Full Name

First

Last

Spouse Name (If Applicable)

First

Last

Email Address

Phone Number

Address

Address Line 1

Address Line 2

City

State

Zip Code

Date of Birth

Emergency Contact

First

Last

Emergency Contact Phone

Emergency Contact Email

Are you a veteran?

Yes
No

Are you a disabled veteran? (copy)

Yes
No

Ethnicity (Used for Grant Applications Only)

How did you hear about us?

Do you have a family member who attends Roll Call?

Yes
No

If yes, please share name.

Military Conflicts and Peacetime

Select all that apply to your service or experience.

Division or Unit

Years Served

Examples 1952-1956, 1982-1990

Medals Awarded

Purple Heart
Silver Star
Bronze Star
Medal of Honor

Select all medals that you have been awarded.

Rank at Discharge

Do you have a Good story about your Military Service? Think You would like to be a Speaker at one of the Luncheons? Please let us know!!

Yes, I have a good story!
No
Maybe I would like to speak to somebody to know more about speaking at an Event.

I agree to submit an RSVP online before each lunch.

Yes
No

Please acknowledge that you must Check In at the desk upon arrival to the Luncheon

Agreed

Please acknowledge that you understand that if you made an RSVP and then cannot attend you must cancel. The Cancellation Link will be on each RSVP receipt in your email.

Agree and Understand

It costs Roll Call $20 each cancellation to cover the cost of the meal. Also, that is a seat that could have been opened for a Veteran.

Please upload photo(s)

Drag & Drop Files, Choose Files to Upload

receipt Medals Cancellation

Additional Information or Comments

Lunch Most 4th Fridays. Check the Calendar!

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