Leap of Faith Program Registration Form

First Name*

Last Name*

Email Address*

Confirm Email Address*

Mobile Phone*

Phone

Address 1*

Address 2

City*

State*

Zip Code*

Name of your fallen service member*

How would you like your fallen's name to be written / presented, if different than the above?

Branch of fallen*

Date of loss*

What is your relationship to fallen service member?*

Why do you want to attend Leap of Faith and what are your expectations ?*

Have you attended a previous Leap of Faith event?*

I understand that final acceptance to Leap of Faith is contingent on an interview with a team member who will be in contact with you. If accepted, you will receive an acknowledgment letter.*

Yes

If you are planning on traveling by plane, please note that there are only two shuttles provided for pick up from the Raleigh-Durham Airport to the hotel on Saturday, November 16th at 1:00 PM and 5:00 PM. When the seminar concludes there will be two shuttles from the hotel to Raleigh-Durham Airport on Wednesday, November 20th at 9:00 AM and 1:00 PM. If you are unable to make these shuttle times it will be your responsibility to pay for transportation from the airport to the hotel upon arrival and from the hotel to the airport for departure. Please check the box to confirm you have read this statement and understand you will be financially responsible for transportation outside of these times.*

Yes, I have read and understand this statement.

I understand that registration is required and any non-registered person will not be allowed at our Leap of Faith event.*

Yes

How will you be traveling? Whether you are flying or driving these expenses are on your own. We do not pay for travel expenses. Please email itinerary to [email protected] as soon as flights are confirmed. If driving, please email us to let us know that as well.*

Are you applying as a tandem parachute jumper or a support person?*

Parachute jumpers must weigh 220 pounds or less to participate in the skydive portion of the event.*

Yes

I understand the tandem parachute jump is not guaranteed and may be cancelled due to weather conditions.*

Yes

If you are a support person, who is the jumper you are attending in support of?

Please provide your support person's first and last name.*

Why did you choose your support person. Please describe.*

Is your support person also a Gold Star Family member?*

Is your support person a family member or friend?*

Please provide your support person's mobile phone number.*

Please provide your support person's email address.*

Parachute jumpers: have you ever tandem skydived before?*

When was the jump?

Where and with which organization did you do your jump?

Unisex T-shirt size*

Do you have any allergies?*

Do you have any dietary restrictions?*

Please note: We will do our best to meet dietary needs, however, we are unable to make any guarantees.

I understand there is a Leap of Faith Event Fee of $55.00 Per Person which is a Refundable Deposit*

The refundable deposit of $55.00 is due as soon as possible after your confirmatin email is received (within two weeks), but no later than October 1st. This deposit reserves your place at the event. If you do not show up or cancel after October 15th, your deposit will not be returned. Please make checks payable to: OSOT-America (please write Leap of Faith on memo line) 1807 S. Washington St. Suite 110, #359 Naperville, IL 60565. Please note that the deposit will be refunded upon completion of the seminar.

How did you hear about Leap of Faith? Please be specific.*

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