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VA Registration

If you would like to make contact with the Home of the Brave program, please reach out to Katie at [email protected].

Main POC Information
Please enter the information for the main point of contact at your VA site. This should be the person that the Home of the Brave Site Coordinator will coordinate with for all activity planning and is usually the CDCE Chief..
Name*
First Last
Email*
Phone*
Preferred Method of Contact*
VA Medical Center Name*
VA Medical Center Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Backup Contact Information
In the event we are unable to get a hold of you, please enter the contact details of a designated backup contact that could answer questions regarding the VA site or Home of the Brave campaign.
Backup Contact Name*
First Last
Backup Contact Email*
Backup Contact Phone*
Number of Inpatient Beds*
Based on anticipated occupancy at your VA Medical Center during Veterans Day week. Does not include outpatients, CBOC, or other facilities.
Please enter a number greater than or equal to 0.

Secondary Site
Complete this section if you are requesting Home of the Brave Veterans Day support for a clinic or Vet Center under your health system. If this does not apply to you, skip to the next page.
VA Medical Health System the Clinic or Vet Center Falls Under:
Clinic or Vet Center Name
Clinic or Vet Center Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Point of Contact Name
First Last
Email
Phone
Preferred Method of Contact
Activity:

Event Details
Please enter details of your event to the best of your ability. We understand that some details may change between now and November, but this is a jumping-off point for our volunteers to get started coordinating the activities.
Select one or more of the activities you would be interested in for your Veterans Day celebration:*
- Luncheon/Dinner/BBQ
- Donuts and Coffee
- Patient Visits
- Veterans Day Ceremony
- Baby Shower
- Other
You selected "Other." Please enter details on what activities you envision:
The more details you enter in this section, the better our Site Coordinators and volunteers will be able to accommodate your activity needs.
Date of the Event (if known at this time):
MM slash DD slash YYYY
Start Time of the Event (if known at this time):

: Hours

Minutes

AM/PM
End Time of the Event (if known at this time):

: Hours

Minutes

AM/PM
Anticipated Number of Volunteers Needed:
Volunteers Will:
Name
This field is for validation purposes and should be left unchanged.

“This nation will remain the land of the free only so long as it is the home of the brave.”
Elmer Davis

Main POC Information