Veteran Online Application

Honor Flight Louisiana gives top priority to WWII, Korean and terminally ill veterans from all wars. To qualify for an Honor Flight, your service must have begun within the official D.O.D. dates listed in the box below and you must have been honorably discharged. Proof of service, such as your DD214 is required. A copy must be submitted with this application in order for it to be accepted.

If you do not have a DD214 form, you can order a copy of your DD214 from this website:
https://www.archives.gov/veterans/military-service-records/

Please scan and email your DD214 or Proof of Military Discharge to info@honorflightlouisiana.org at the time you submit your online application.


Service Information
War(s) Fought *
In which war(s) did you serve? Check all that apply to you.
Personal Information
Name *
Name
Address *
Address
Date of Birth *
Date of Birth
Home Phone
Home Phone
Mobile Phone *
Mobile Phone
Choose from the drop-down menu.
Choose from the dropdown menu.
Must be a generation younger; no spouses or significant others.
Primary Emergency Contact Information
Someone available the day you travel.
Phone *
Phone
Non-Spouse Alternate Emergency Contact
son, daughter, etc.
Phone *
Phone
Service History
NOTE: DD214 or Proof of Military Discharge Required
Branch *
Ex: MM/DD/YYYY - MM/DD/YYYY
Medical Information
Medical Equipment Used *
Please check all that apply.
Do you use oxygen at any time? *
If YES, oxygen will be provided during the flight and tour of Washington, D.C. as needed.
Do you have any drug allergies? *
If YES, please list below.
Do you have a history of seizure? *
If YES, please describe in the form below: a) What type (grand mal, petit mal, etc.)? b) When was your last seizure? NOTE: If a seizure has occurred in the last five (5) years, it is STRONGLY advised you discuss the trip with your private physician!
Do you have problems with motion sickness (sea or air)? *
If YES, please state in the form below whether it is controlled through medication. NOTE: If motion sickness is not controlled with medications, it is STRONGLY advised you discuss the trip with your private physician!
Do you use a home nebulizer machine? *
NOTE: If YES, you are STRONGLY encouraged to discuss the trip with your private physician concerning the use of portable hand-held nebulizers during the trip.
Do you have a problem walking the length of a football field without assistance? *
Do you have a history of open head injuries, sinus problems, or ear problems? *
If YES, please state in the form below if you have flown since the open head injury, sinus, or ear problems occurred. If YES, did you have any problems? If YES, it is STRONGLY advised you discuss the trip with your private physician. If you have NEVER flown since the open head injury, sinus or ear problems, again we STRONGLY advise you discuss the trip with your private physician.
Do you have a urostomy or colostomy bag? *
NOTE: If YES, please make sure the bag is vented prior to flight. If you do not know if your bag is vented, it is STRONGLY advised that you discuss this issue with your private physician.
Do you have a pacemaker? *
Are you a diabetic? *
Do you have any special dietary needs/requirements? *
If YES, please explain in the form below.
PLEASE REVIEW CAREFULLY AND SIGN:
The undersigned acknowledges and agrees that: 1. As photographic and video equipment are frequently used to memorialize and document Honor Flight trips and events, his/her image may appear in a public forum, such as the media or a website, to acknowledge, promote or advance the work of the Honor Flight program. I hereby release the photographer and Honor Flight Louisiana, Inc. from all claims and liability relating to said photographs. I hereby give permission for my images captured during Honor Flight activities through video, photo, or other media, to be used solely for the purposes of Honor Flight promotional material and publications, and waive any rights or compensation or ownership thereto. 2. I further state that medical insurance is the responsibility of the veteran and I understand that neither Honor Flight Louisiana, Inc. nor the provider of free private aircraft (“Flight Provider”) provides medical care. I understand that I accept all risks associated with travel and other Honor Flight Network activities and will not hold Honor Flight Louisiana, Inc., the Flight Provider, or any person appearing or quoted in any advertisement or public service announcement for or on behalf of Honor Flight responsible for any injuries incurred by me while participating in the Honor Flight program.
Have you ever flown on an Honor Flight at any time in the past, with any Honor Flight organization? *
(Ex: "s/John Smith")
Date of Signature *
Date of Signature
***NOTE ONLY COMPLETE AND SIGNED APPLICATIONS WILL BE CONSIDERED***