Nominate Yourself for a Recharge

Please use the form below to nominate yourself for a recharge!

Your Full Name

Branch of Service

Years Served

Date of Birth

Month

Day

Year

Email

Phone

Address

In a few sentences, please tell us about yourself, including any hobbies or interests.

Family Member(s) Attending (if any). Please list their first and last name, relationship to you, age, and if interested in activities (Y/N).

Describe any relevant outdoor or adventure experience:

Select Preferred Activities

Discover Scuba (Introductory session with certified instructor)

Shark Fishing (Catch & release, guided)

Kayaking Adventure (fresh or saltwater routes)

Hunting Experience (includes safety training if required)

Medical conditions or mobility concerns:

Do you have your own gear?

Yes

No

If yes, please list:

Availability

Weekdays

Weekends

Flexible

Specific dates available (if known)

Why do you want to participate?

Photo/Media Release: Do you consent to photos/videos being taken for use in promotional materials?

Yes

No

Applicant's Signature

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