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* 1. Veteran's First Name 
(enter veteran's legal first name)

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* 2. Veteran's Last Name 
(enter veteran's legal last name)

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* 3. Veteran's Driver's License or Identification Number 
(enter the veteran's full state driver's license or state identification number, including any letters)

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* 4. DL or ID State of Issue
(enter the 2 letter abbreviation for the state that issued the veteran's driver's license or ID card)

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* 5. Veteran's Date of Birth
(mm/dd/yyyy)

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* 6. Veteran's Court Case Number or Case Type that is pending, if known
(enter the Hillsborough County court case number with all letters and numbers or the type of case that is pending in Hillsborough County)

Please provide the following information so that we may communicate with you regarding the Veteran's Outreach Court event.

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* 7. Veteran's Contact Phone Number
(enter the phone number with area code where the veteran can be reached or where messages can be left)

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* 8. Is the phone number entered in question 7 the veteran's phone or someone else's phone?

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* 9. Veteran's Contact Email Address
(enter the email address that the veteran can receive email about the Veteran's Outreach Court at)

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* 10. Is the email entered in question 9 the veteran's email or someone else's?

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* 11. Veteran's Street or Mailing Address
(What is the veteran's street address or mailing address for communications about the Veteran's Outreach Court, including the hearing notice?)

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* 12. Veteran's City State and Zip Code
(what is the veteran's city, state and zip code?)

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* 13. What is the preferred method of communication for the veteran?

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* 14. If someone else registered the veteran for this event, what is your name?
(please enter your name and your relationship to the veteran)

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* 15. Is the veteran enrolled in Veterans Health Care Services?

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* 16. Will the veteran need a new driver's license issued if their driver's license is reinstated?

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* 17. How did you hear about this event?

By registering for this event, you (or the veteran) authorize the Hillsborough County Clerk of Court and Comptroller to provide your driving history and/or court history record to the Florida State Attorney's Office, the Public Defender's Office, or volunteer attorneys for the purpose of running screenings for this event. You also authorize the Clerk to update your files with the above-listed contact information.

Click "Done" to submit this registration.

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