Wisconsin Women Veterans Registry

Women Veterans Registry

Prefix

First Name

Last Name

Address Line 1

Address Line 2

City

State

Zip Code

County

Phone

Cell: (if Different)

Service Branch (check all that apply)

Army

Navy

Air Force

Marines

Coast Guard

Army Reserve

Navy Reserve

Marine Reserve

Air Force Reserve

Coast Guard Reserve

Air National Guard

Army National Guard

Space Force

Are you currently serving the military?

Yes No

Dates of Service - Entry:

Dates of Service - Discharge:

Are you retired from the military?

Yes No

Are you a member of a tribe?
Yes No

Are you a Veteran Owned Business owner?
Yes No

Are you married?
Yes No

Do you have dependent children under the age of 18?
Yes No

What are you interested in being informed about? Select as many as apply from the list below:

Women Veteran Information

Veteran Benefits

VA Healthcare

Mental Health Care

Education Benefits

Veteran Small Business

Employment/Employer Opportunities

Veteran Discounts

Preferred Method of Contact