Home > Gift-a-Vet Wish List Participation Form

Please complete the following information if you are interested in participating in the Gift-a-Vet program:

[contact-form to=’community.support@nechv.org’ subject=’Gift-a-Vet Wish List Registration’][contact-field label=’First Name’ type=’name’ required=’1’/][contact-field label=’Last Name’ type=’name’ required=’1’/][contact-field label=’Email’ type=’email’ required=’1’/][contact-field label=’Organization’ type=’text’/][contact-field label=’Mailing Address’ type=’text’ required=’1’/][contact-field label=’State’ type=’text’ required=’1’/][contact-field label=’City’ type=’text’ required=’1’/][contact-field label=’Zip’ type=’text’ required=’1’/][contact-field label=’# of Wishlists’ type=’text’ required=’1’/][contact-field label=’Have you participated in the Gift-a-Vet program in the past?’ type=’radio’ required=’1′ options=’Yes,No’/][contact-field label=’Comment’ type=’textarea’][/contact-form]