0929f Participant Agreement, National Veterans Creative Arts F

OMB Number:
Respondent Burden: 20 minutes

PARTICIPANT AGREEMENT
NATIONAL VETERANS CREATIVE ARTS FESTIVAL
DEADLINE:
RESPONDENT BURDEN: The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the
clearance requirements of Section 3507 of the Paperwork Reduction Act of 1995. We may not conduct or sponsor, and you are not required to respond
to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who must complete this
application will average 20 minutes. This includes the time it will take to read instructions, gather the necessary facts and fill out the forms.

No Alcohol/No Illicit Drugs
The National Veterans Creative Arts Festival is an alcohol-free/illicit drug-free program. Participants, staff, and
volunteers involved in the Festival are asked to refrain from the use of alcohol and illicit drugs during this event.
We ask that you sign your name in the space below, indicating that you have read the activity descriptions of the
Festival week events and are willing to participate with what has been outlined. Thank you for your time in
reviewing this information and we hope to see you in
!

PARTICIPANT SIGNATURE

DATE

STAFF SIGNATURE (to confirm veteran's understanding of the above statements)

DATE

Please submit Participant Agreement Form no later than

to:

LINDA ZAIONTZ, HOST SITE COORDINATOR (11K)
SOUTH TEXAS VETERANS HEALTH CARE SYSTEM
7400 MERTON MINTER BLVD.
SAN ANTONIO, TX 78229
PHONE: (210) 617-5125
FAX: (210) 617-5276
linda.zaiontz@va.gov

VA FORM
JUN 2010

0929f

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