Veterans Connect Contact Form

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Fill out this form and we will contact you.

Email *

Name *

Phone Number *

Preferred Method of Contact *

Phone

Text

Age *

Branch of Service *

How many Years of Service? *

Are you a current YMCA Member at Lebanon or Landen? (Membership not required) *

Yes, Lebanon

Yes, Landen

I am not a member

Shirt size *

Would you prefer a morning or evening session? *

Morning

Evening

Required Forms

If you are already a Countryside YMCA member (Lebanon or Landen), please complete our medical history form and bring it with you on the first day of class.

If you are not a Countryside YMCA member, please complete our medical history form and our membership application and bring both of them with you on the first day of class.

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Note: DO NOT share personally identifiable information (PII) over the internet. If you are unable to print your own form(s), Mike will have spare copies on the first day of class.

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