Operation Tohidu - MST Retreat Squad Cohort #2
** Registration Extended!**

Welcome!
We are so excited that you have taken the first step to joining the second cohort the Squad. 

RISE: Veterans in partnership with Melwood is building a cohort to join their MST-specific retreat this Fall. This will allow for an opportunity to connect female veteran survivors with shared experiences to one another.

If you are interested in joining the next Melwood retreat please provide the below information by August 10th.

Virtual sessions begin August 17th and end with an in-person retreat September 15-18th. 
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Email *
Name (First & Last) *
Phone Number *
Email Address *
Address *
Date of Birth *
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Age *
How would you describe your race? *
What is your marital status? *
Are you a parent or legal guardian? *
What is your highest level of education? *
What is your current employment status? *
Branch of Service *
What was your military occupational specialty? (MOS/Rate) *
Highest Rank Held *
During your time in the military, did you ever deploy to a combat zone? (This includes any area where you received combat duty pay.) *
What years did you serve in the military? Please include all active, reserve and/or guard duty time. (ex. Navy, Active, 2007-2011) *
Are you currently working with a mental healthcare provider? *
Do you have any special dietary requirements? If yes, please describe: *
Will you be accompanied by a certified/registered service animal? If yes, please describe: *
Do you require any special physical accommodations? If yes, please describe: *
What is your (unisex) shirt size? *
Emergency Contact Full Name #1: *
Phone #1: *
Email Address #1: *
Emergency Contact  Full Name #2: *
Phone #2: *
Email Address #2: *
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