Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastBVA Member Number *Phone *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingState / TerritoryPostal CodeEmail *Handler's Branch of Service *U.S. Army VeteranU.S. Marine Corps VeteranU.S Navy VeteranU.S. Air Force VeteranU.S Coast Guard VeteranU.S. Space Force VeteranPlease choose the primary branch of service you would like listed next to your first name. Dog's Name *Dog's Birthdate *Dog Breed *Dog's Training School *What month and year did you and your Dog become a Team? *Do you want the handler name to appear on the card? *YesNoDue to privacy and spacing issues, only the first name of the handler will be listed. The Dog's name will be on the front of the card and the Handler's first name and branch of service will be listed on the back. Favorite Breed Dog's Please choose one *Guide DogService DogA guide dog is a service dog, but some of our members have a service dog that is not a guide dog. Dog's Top Three Favorite Things (this could be a favorite toy, treat, or place to visit or work)Upload a vertical photo of your dog (you can choose a solo image of your dog or a photo with dog and handler) * Drag & Drop Files, Choose Files to Upload Submit Application
