***All information is kept confidential

This form is for those who wish to assist our wounded Heroes and their families

with airline miles for flights. O.F.R. will contact you when a flight is needed.  Please fill out the appropriate

fields and use the 'submit form' button at the end of the form.  Thank you.

• Please provide the following contact and flight miles information that applies:

  Name
  Street Address
  Address (cont.)
  City
  State/Province
  Zip/Postal Code
  Country
  Work Phone
  Home Phone
  Cell Phone
  FAX
  E-mail
  Approx. miles to donate
  Airline(s) you have miles with
  Time of day to contact you	Morning  Afternoon  Evening
  Please enter approximate date you would like to be contacted:	-- mm/dd/yy