Form Center

2. 
3. Middleborough Veterans ID Card Application
7. Name*
8. Email Address
10. Address*
12. Phone Number*
13. Branch of Service*
    -- Select One --ArmyMarinesNavyCoast GuardAir Force
15. Current Status*
    -- Select One --VeteranActive DutyReservesNational Guard
16. Can the Veterans' Service Office send you flyers and other correspondence on events related to Veterans that are going on in your area? If yes, would you prefer correspondence via email or mail?

    1. Yes
    2. No

    1. Email
    2. Mail
18. Would you like to volunteer to help fellow veterans? If yes, what type of volunteering would you be able to do?

    1. Yes
    2. No
    3. Landscaping / Mowing Yards
    4. Snow Removal
    5. Simple Home Repairs
    6. Complex Home Repairs
    7. House Cleaning
    8. Transportation to Doctors Visits
    9. Transportation for Grocery Shopping / other Shopping
    10. Hospice Care
    11. Other
19. Other? Please Describe...
21. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
23. Electronic Signature*
Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit Submit and Print

* indicates a required field