Veterans Bridge Home Newsletter Registration Please fill out the following to get on our distro list and get connected. Question Title * 1. First Name Question Title * 2. Last Name Question Title * 3. Status Veteran Family Civilian Volunteer Other Question Title * 4. Date of Birth (mm/dd/yy) Question Title * 5. Gender Male Female Question Title * 6. Branch of Service Army Navy Airforce USMC Coast Guard Question Title * 7. Rank at Exit Question Title * 8. Service Start Date (mm/dd/yy) Question Title * 9. Service End Date (mm/dd/yy) Question Title * 10. At what email address would you like to be contacted? Question Title * 11. Phone Number Question Title * 12. Preferred Contact Method Email Phone Text Question Title * 13. How did you hear about Veterans Bridge Home? Question Title * 14. I am interested in learning more about: Volunteering in the community at events Volunteering at VBH Office Time & Talent (Leading or collaborating on outside events.) Mentoring Wednesday Morning Workouts Networking Special Events Other (please specify) Question Title * 15. NCServes consent.We thank you for requesting assistance from the first ever coordinated network of providersserving Veterans and Military Families. By requesting assistance from an organization within thenetwork (named NCServes), you will have access to a plethora of public and privateorganizations that can assist with a multitude of services. In doing so, the network will worktogether to service your needs in the most efficient way. I give my permission for enrollment into programs with services and or training which may be funded bya local, state or federal department or agency. I have been informed that these funding sources mayverify service activities reported by the NCServes Coordination Center in order to comply with theserequirements.By agreeing to this consent and authorization form, you authorize your information to be inputted into adigital referral system. In doing so, you will not hold liable any parties involved in the network, or theinternet and website provider. I give my consent to share my information within the NC Serves network. I do not give my consent to share my information within the NC Serves network. Done