0926g National Veterans Golden Age Games, Non-Competitor Regis

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

NATIONAL VETERANS GOLDEN AGE GAMES
NON-ATHLETE REGISTRATION CHECKLIST
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.

REGISTRATION DEADLINE IS MARCH 28, 2014
NON-ATHLETE FORMS
NON-ATHLETE APPLICATION (VA Form 0926h)

PLEASE RETURN COMPLETED PACKETS TO:
Carol Kick, 2014 LOC Coordinator (135)
VA Health Care System of the Ozarks
110 N College Avenue
Fayetteville, AR 72703

VA FORM
FEB 2014

0926g