Required
First Name
Required
Last Name
Required
Date of Birth
Required
Address Line 1
Required
City
Required
State
Alabama
Alaska
America Samoa
Arizona
Arkansas
California
Colorado
Connecticut
D.C.
D.C.
Delaware
Federated States of Micronesia
Florida
Foreign Correspondence
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Trust Territory
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Required
Zip
Required
Phone
Required
Email
Required
I am a
Veteran who wants to share my story
Volunteer who knows a veteran and wants to share their story
Required
Branch of Service
Required
Years in Service
War Conflicts (if applicable)
Required
I understand that the Office of Congresswoman Beth Van Duyne plans to retain the product of my participation in the VHP, including but not limited to my interview, presentation, video, photographs, statements, name, images or likeness, voice, and written materials ("My Collection"). I hereby grant to the Office of Congresswoman Beth Van Duyne the right to use and distribute the materials in My Collection in any medium
I Agree
Required
Veteran's First Name
Required
Veteran's Last Name
Required
Branch of Service
Required
Years in Service
War Conflicts (if applicable)
Required
I want to
Conduct an interview for the veteran listed above.
Collect and donate items from the veteran listed above.
Connect the veteran listed above with Rep. Van Duyne’s office to conduct an interview.