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Immediate family members or a representative of a Veteran not capable of completing this form may fill out any and all information relevant to the assistance of the Veteran.

Service Information
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First Name
Last Name
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country

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Select all that apply
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Each veteran/navigator will be required to ride as a passenger in a car and perform “typical” rallye navigator duties including: opening navigator’s envelope, holding up transponder at start/finish, handling, reading, interpreting rules, clues, and directions. Please remember, drivers are bringing their personally owned vehicles and these cannot be retrofitted in anyway.
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DD214 (preferred) or Proof of Service letter or discharge papers

Copy of Driver’s License or other form of Government issued ID

VA ratings sheet and VA Ratings Breakdown (preferred) or MEB/PEB findings