0924a National Disabled Veterans Winter Sports Clinic, Registr

OMB Number: 2900-0759
Expiration Date: Xxx, 20XX
Respondent Burden: 15 minutes

NATIONAL DISABLED VETERANS
WINTER SPORTS CLINIC
REGISTRATION CHECK LIST
You must completely and correctly fill out the enclosed packet, or your application will not be processed!
Registration deadline is
. A $50 late fee will be charged to any application received
after
through
.
Applications postmarked after

will not be accepted!

Please do not fold or staple application.
YOU MUST INCLUDE THE FOLLOWING FORMS FILLED OUT COMPLETELY. DO NOT SEND APPLICATION
WITHOUT ALL OF THE FOLLOWING:
REGISTRATION APPLICATION (Filled out by participant) (VA Form 0925SF)
GENERAL MEDICAL/PHYSICAL EXAM FORM (Must be filled out completely and signed by examining clinician) (Make sure
problem list, EKG for age 40 and over, and current medications list is included in addition to the two medical pages) (VA Form 0924d)
GENERAL SKI INFORMATION (Filled out by participant as accurately as possible) (VA Form 0924c)
CONSENT FOR USE OF PICTURE (VA Form 10-3203)

Please allow four weeks for your application to be processed. When accepted, you will receive
information regarding hotel and flight reservations and ground transportation.
To avoid confusion and possible loss of funds, please do not make any travel or lodging reservations
until you have received the letter notifying you that your application has been accepted.

All applications and forms must be mailed to:
Teresa Parks
National Disabled Veterans Winter Sports Clinic
VAMC (WSC)
2121 North Avenue
Grand Junction, CO 81501

VA FORM
FEB 2014

0924a