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? For example, would you like their branch and rank listed or simply their full name?

Branch of fallen*

Date of loss. Please note, that your date of loss must be over one year ago to have the most beneficial experience from the seminar.*

What is your relationship to fallen service member? For example, are you the spouse, parent, or sibling of the above named fallen service member?*

Was your loss Combat Related or Non-Combat Related? If Non-Combat related, please explain/provide details (please indicate if the Non-Combat related loss was service-connected).*

The event is about the seminar and learning new ways to process grief and find ways to move forward despite their terrible loss in a way that honors their loved one. The activities like the equine therapy and tandem skydive are meant to be transformational and not experiential. The activities are designed to enhance what is learned in the seminar. It is not about the activity per se. 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 1st 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 5th at 9:00 AM and 1:00 PM. If you are unable to make any of these shuttle times, transportation to and from the seminar is the responsibility of the attendee to pay for transportation from the airport to the hotel upon arrival and from the hotel to the airport for departure. The cost of an Uber to the hotel is approximately $100. 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. If you are unable to make any of the shuttle times provided in the statement above, you will need to arrange your own transportation at your expense. An Uber is approximately $100 to the hotel from Raleigh-Durham Airport. Please email itinerary to [email protected] as soon as flights are confirmed. If driving, please email us to let us know as well.*

Are you applying as a primary participant or a support participant?*

Primary participant (parachute jumper) 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 attending as a Support Participant, your role is to help the person you are supporting by helping process information and offer comfort, empathy, care and reassurance. You will also aid them in coping with stress or emotional difficulty during the event. The Support Participant should also be a resource to you upon your return home after the event. Please explain how you see yourself supporting the person you will be here for?*

If you are a support participant, who is the primary participant you are attending in support of?

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

Why did you choose your support participant? Please describe.*

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

Is your support participant a family member or friend?*

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

Please provide your support participant's email address.*

Primary participant: have you ever tandem skydived before? This is a once in a lifetime opportunity to attend as the Primary Participant, however, you may attend in the future as a Support Participant for another Gold Star family member.*

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? We will do our best to accommodate dietary restrictions, however, we are unable to make any guarantees. We recommend you bring some back up options.*

I understand there is a Leap of Faith Event Fee of $55.00 Per Person which is a Refundable Deposit and is due by September 15, 2025.*

The refundable deposit of $55.00 is due as soon as possible after your confirmation email is received (within one week), but no later than September 15th. 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. You can also pay the deposit via credit card.

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

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