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Home
About
About The Program
Placer Reset
Outdoor Adventures & Retreats
Affiliates
Veteran Services
Ways To Support
Micros For A Cause
Garden
Upcoming Events
Sponsors
Contact
Donate
Square Donation
PayPal Donation
Brick Donation In Garden
Retreat Application
Details
Please select which event you are applying for
(Required)
PLEASE SELECT
June 6, 2023 Bike Retreat
Name
(Required)
First
Last
Email
(Required)
Enter Email
Confirm Email
Phone
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Classification
(Required)
PLEASE SELECT
AD Military
Veteran
First Responder
Are you a Veteran?
(Required)
Yes
No
Branch of Service
(Required)
PLEASE SELECT
Marine Corps
Marine Corps Reserve
Army
Army Reserves
Army National Guard
Navy
Navy Reserves
Air Force
Air Force Reserves
Air National Guard
Coast Guard
Coast Guard Reserves
N/A
Disability Rating
Is your Disability Rating Service Related?
(Required)
PLEASE SELECT ONE
Yes
No
N/A
Theater of Deployment
First Responder Title
(Required)
PLEASE SELECT ONE
Police Department
Firefighter
EMT/Paramedic
Dispatcher
N/A
Have you Previously Attended One of Our Retreats?
(Required)
PLEASE SELECT ONE
Yes
No
If So, Which One?
Physical Limitations / Needs
(Required)
Please Tell In 100 Words Why You Would Like To Attend
(Required)
Do You Have Any Experience In This Activity? Please Explain
(Required)
How Did You Hear About Us?
(Required)
Photo ID
(Required)
Max. file size: 100 MB.