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Veteran Registration Form

2. Important Information
   This form is for residents of Mansfield, TX who are veterans. The City is creating a database to provide information to veterans on specific events and programs in Mansfield. This form should be completed by the individual whose information is being provided. This information will not be sold to companies or organizations outside the City of Mansfield.

   This form is for residents of Mansfield, TX who are veterans. The City is creating a database to provide information to veterans on specific events and programs in Mansfield. This form should be completed by the individual whose information is being provided. This information will not be sold to companies or organizations outside the City of Mansfield.

4. First Name of Veteran*

5. Last Name of Veteran*

7. Address*

9. City

10. State*

11. Zip Code*

13. Phone Number*

14. Email Address

16. Branch of Service*
    -- Select One --United States Air ForceUnited States ArmyUnited States Coast GuardUnited States Marine CorpsUnited States Navy

17. Years of Service (Ex. '41-'45; YY-YY)

18. Status*
    -- Select One --Active DutyHonorably DischargedReserveRetired

20. Military Rank*

21. Conflict(s) in which you served. (WWII, Vietnam, etc.) If none, leave this field blank.

23. Photo

    If available, please upload a photo of you in uniform during your military service.

25. Electronic Certification

    By checking the "I agree" box below, you agree and acknowledge that 1) all provided information is true 2) you have served at least 1 day active military duty and 3) you retired, were honorably discharged, or are actively serving.

    1. I agree.
27. Electronic Signature

Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field