2. 

4. $25 Per Person

   Register before October 15th to ensure you get the proper size t-shirt.

6. First Name*
7. Last Name*
9. Are you an Active or Prior Service Member>*

   1. Yes
   2. No
10. Branch of Service
11. Dates of Service
13. Email*
15. Street Address*
17. City*
18. State*
19. Zip Code*
21. T-Shirt Size*

    1. XS
    2. S
    3. M
    4. L
    5. XL
    6. XXL
    7. XXL
23. Payment Method*

    1. Cash
    2. Check (Payable to VVA219)

    If filing online, payment can be mailed to Westfield Veteran Services, 45 Noble Street, Westfield MA 01085.

Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field