Eastern Iowa Honor Flight | Guardian Registration Form

Guardian Information

First Name

Middle Name

Last Name

Nickname (if used)

Date of Birth

Gender

Male Female

Contact Information

Street Address

City

State

Zipcode

County

Evening Phone

Mobile Phone

Email Address

Service History

Are you a Veteran?

Yes No

Emergency Contact

The Emergency Contact should be someone available on the day of the trip.

First Name

Last Name

Relationship

Evening Phone

Mobile Phone

Alternate Contact

First Name

Last Name

Relationship

Evening Phone

Mobile Phone

Medical Information

Do you have any food allergies?

Yes No

Additional Information

T-Shirt Size

Are you willing to assist all veterans, and are you willing to push any wheelchair?

Yes No

Can you lift 100 pounds?

Yes No

Are you requesting to travel with a specific veteran, if possible?

Yes No

Remarks / Comments:

Additional Questions

Guardian: List the name of the veteran(s) you would like to accompany on an honor flight:

Are you willing to be a guardian for a 2nd veteran the day of flight?:

There is a fee to be a guardian on an Honor Flight:

Yes, I acknowledge there is a fee paid prior to flight.