Online Veteran Application – Honor Flight Southern Nevada

Please use this form to complete your Veteran Application to Honor Flight Southern Nevada.

PLEASE BE AWARE: The Transportation Security Administration is reminding travelers that beginning October 1, 2020, every traveler must present a REAL ID-compliant driver’s license, or another acceptable form of identification, to fly within the United States

Online Veterans Application

Instructions Please complete the following application to experience your Tour of Honor with Honor Flight Southern Nevada. Once the application is submitted to Honor Flight Southern Nevada, we will review the application for completeness and be in touch.
Date *

Veteran Information

Name *Provide your name as shown on driver's license or gov't issued ID. PLEASE BE AWARE: The Transportation Security Administration is reminding travelers that beginning October 1, 2020, every traveler must present a REAL ID-compliant driver’s license, or another acceptable form of identification, to fly within the United States
If you do not have a Apt, Suite, Bldg. number, please enter "none"
Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Email *
Home Phone *
Mobile Phone
Date of Birth *
Age *
Nickname for Nametag
T-Shirt Size *
You will be provide a Honor Flight Southern Nevada T-shirt to wear on the trip.SmallMediumLargeX-LargeXX-Large
Gender *
FemaleMale
Have you been on an Honor Flight before? *
If yes, Sorry you may only go on any Honor Flight once.YesNo

Veteran Service History

Emergency Contact Information

Primary Emergency Contact *Please provide who HFSN may contact in the event of an emergency.
If you do not have a Apt, Suite, Bldg. number, please enter "none"
Emergency Contact Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Emergency Contact Phone *
Emergency Contact Email *
Emergency Contact Relationship to Applicant: *

Emergency Contact Information - Secondary Contact

Emergency Contact No. 2 *Please provide who HFSN may contact in the event of an emergency.
If you do not have a Apt, Suite, Bldg. number, please enter "none"
Emergency Contact No. 2 - Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Emergeny Contact No. 2 - Phone *
Emergency Contact No. 2 - Email *
Emergency Contact Relationship to Applicant: *

Guardian Information

Honor Flight Southern Nevada will provide a wheelchair for each Veteran as needed, as well, as an Honor Flight Southern Nevada Guardian. These guardians will accompany and assist you throughout the day to help ensure a safe and memorable experience. If you believe there is a medical need that necessitates a family member be considered to act as your guardian, they must be in good health, and be able to push a 300lbs in a wheelchair for 8 hours and lift 100lbs, if needed. Please list that person’s contact information below and ask the family member to complete a guardian application found at www.honorflightsouthernnevada.org Guardians must attend a training class and pay a fee that covers a portion of the cost of the three day trip. Completion of the Guardian Application combined with your written request below, will assure that your request is considered, however selection is not guaranteed. Your spouse or significant other is NOT eligible to accompany you on the flight.
Are you taking a guardian with you? *
If you chose No, HFSN will assign a guardian to you for your trip.YesNo
If Yes, did Guardian complete application?
The guardian application must be completed, and guardian is aware they pay for their trip costs of $900.YesNo
Guardian Name
If you do not have a Apt, Suite, Bldg. number, please enter "none"
Guardian Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Guardian Home Phone
Guardian Mobile Phone
Guardian Email
Relationship to Veteran

Medical History

In the box below, list ALL medicine, including dosage and frequency taken. Information provided WILL NOT disqualify you, however, we must ensure you are able to endure the travel. DAY OF FLIGHT - Please remember to bring a supply of your medication to last 5 days
Medical Information: *
This information allows us to assess the support we may need during the trip. This information is for HFSN and Medical Staff Only. IT IS STRONGLY ADVISED THAT YOU CONSULT YOUR PRIVATE PHYSICIAN BEFORE MAKING THIS TRIP. HAVE THEM PROVIDE A MEDICAL HISTORY AND LIST OF CURRENT PRESCRIPTIONS FOR YOU TO TAKE ON THE TRIP.
Medication Information If you have your medication information on a list, please take a photo and upload the photo.
Your Primary Physician's Name: *
Primary Physican's Phone *
Provide the date of your last physical exam *
I understand that if I do not complete my medical and current prescription information, my application may not be accepted by Honor Flight Southern Nevada. *
Yes

PLEASE REVIEW CAREFULLY:

PLEASE TYPE YOUR NAME IN THE BOX BELOW, ACKNOWLEDGING YOU AGREE TO THE STATEMENTS BELOW *
The undersigned acknowledges and agrees that: 1. As photographic and video equipment are frequently used to memorialize and document Honor Flight Southern Nevada (HFSN) and the Honor Flight Network (HFN) trips and events, his/her image may appear in a public forum, such as the media or a website, to acknowledge, promote or advance the work of HFSN and the HFN program. I hereby release the photographer and HFSN and the HFN from all claims and liability relating to said photographs. I hereby give permission for my images captured during HFSN and the HFN activities through video, photo, or other media, to be used solely for the purposes of HFSN and the HFN promotional material and publications, and waive any rights of compensation or ownership thereto. 2. I further state that medical insurance is the responsibility of the veteran and I understand that HFSN and the HFN does NOT provide medical insurance. I understand that I accept all risks associated with travel and other HFSN and the HFN activities and will not hold HFSN and the HFN responsible for any injuries incurred by me while participating in the HFSN and the HFN program. By submitting this application electronically, you are signing that you have read and agree with the above statements.

Verification: Enter any two numbers of your choice in the box below.

*Example: 12
This box is for spam protection - please leave it blank: