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First Name *

Last Name *

Address *

City *

State *

Postal code *

Email *

Phone *

Branch of Service *

M.O.S. *

Active or Retired? *

Combat Related PTSD or MST? *

Yes

No

Have you fished with us before? *

Yes

No

Do you Need any Special Assistance? *

Do You Want to Fish Inshore or Offshore? *

When Are You Available to Fish? *

Weekdays

Weekends

If You Live Close To Our Ports of Call, Are You Willing To Fill A Last Minute Vacancy? *

Yes

No

Emergency Contact

Emergency Contact Phone Number

Comments or Anything We Should Know?

Do You Agree To Our Liability Terms? *

Yes

No

I agree that if I have a TBI, inner ear issues, vertigo or any condition that may make me sea sick that I will start taking sea sickness preventative measures 36hr before the trip at 12hr intervals, or start a sea sickness regiment. Failure to do so will cause the boat captain to turn the vessel around and taking a trip away from the other veterans on the trip. *

Yes, I Agree

No, I Do Not Wish To Take Part In a Trip

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