Street Address ONLY (ex: 1861 Gettysburg St) Please put the city, state, and zip on the following modules. *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Cell Phone # *
Your answer
Branch of Service *
Years of Service? ex: 1997-2004 *
Your answer
What was your MOS? *
Your answer
Were you in a combat area? *
Please select that which applies to you: *
Required
What location were you stationed and/or military campaign? *
Your answer
What year were you injured? What military campaign/location did the injury occur? *
Your answer
Please give some details of your service and/or injury so we can match up with other OpCbend Participants. (We will not share this info with others. Please be honest and provide as much info as you can.) *
Your answer
Please select all that apply: *
Required
What is your Disability Rating? (Closest) *
Please list any other physical injuries not listed above. ( Please be honest and thorough. It helps us plan excursions and services needed. This info will not be shared or made public.) *
Your answer
Do you use a wheelchair or track chair? *
Do you require transferring equipment or assistance for the accommodations or vehicles? *
Will you need to be booked off site for a hotel ADA room? *
Are you willing to push yourself to attend and participate in the activities of the event? *
This event is is a camp atmosphere with RV or Tent accommodations. You will be well fed, entertained with live music, and expected to engage and participate in activities with other veterans and crew. *
This is not an event with therapy or professional services. This is an event to build a veteran network of folks just like you. However, you could experience some emotions as you would when getting together with other veterans. It could possibly drum up some memories but you would have the support of your brethren to push through it. Do you understand and acknowledge you are able to attend and participate? *
Can you drive yourself to the event? *
Will you need to fly in to the event? *
Do you have a sponsor that would pay for your travel to the event if you are located outside of Ohio? *
Can you commit to this years event? We need a solid commitment for your participation. *
Why do you want to attend this particular event? What would make you a good fit for this event? (Please take the time to answer honestly and completely. We really read this and it helps us to select the new participant class.) Please tell us about yourself. We will keep this confidential. *
Your answer
What activities do you like the BEST? *
Required
What activities do you like the LEAST? *
Required
Is there anything else you would like us to know about you? *
Your answer
Can you please list a person as a reference that we may contact? ( Not a family member.) Or someone you know who has participated in OpCbend. *
Your answer
Please list an Emergency Contact to keep on file. (Name and Cell number) *
Your answer
Please list your Spouse or Partner. (Name and Cell #) *