Service Member Sign Up Form

Please complete the form below to express interest in the Citizen Soldier Connection program. Note: Disclosure of information requested on this form is voluntary and constitutes consent to release this information to The Citizen Soldier Connection.

Once you complete the sign up form below, we will seek to match you with a person who shares your interests and hobbies. We are a new organization, just getting started, so don't give up if you don't get a connection immediately. We will contact you as soon as we are able.

Information obtained will be used for the sole purpose of connecting citizens with soldiers and shall remain confidential.

*All fields in BOLD are required.

Service Members Name
Mailing Address
City
State:
Zip Code
E-mail
Phone (work, home, cell)
Your Unit
Your Rank
Age
Gender
Your Homestate
Marital Status
If married, your spouses name:
Names & ages of any children (optional)
Please list a few of your favorite acitivities or hobbies:
Service Member does not want to be connected with citizens who:


Do you have transportation?

Additional Information:
I have read and understand the disclaimer below.
Type the letters/numbers you see in the image below:
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Disclaimer: The Citizen Soldier Connection (CSC) is a voluntary program for both citizens and soldiers.  While CSC facilitates the connection between citizens and soldiers in order to accomplish its mission and thereby, to benefit soldiers and citizens, CSC does not assign soldiers or citizens to one another.  The connection of individuals is based on an apparent match that takes into consideration a variety of factors, including information provided by both soldiers and citizens, which leads to the introduction of a soldier and citizen to one another.  Once the introduction is made, it is solely for the soldier and citizen to decide whether to establish and pursue a relationship and activities contemplated by the mission of CSC.  CSC provides not assurance that the connection will work to the satisfaction of anyone, in either the short or long term, and CSC makes no promises and bears no responsibility regarding the character, conduct, or actions of any participants in the program.  The soldier and citizen each fully accepts and bears any and all risks associated in any manner with the activity, conduct, misconduct, actions or inactions of the person whith they choose to establish a connection.  Each soldier and citizen who chooses to particpate in the CSC program must, as a condition of participating in the program, agree to the terms of this Participant Waiver and Release Form.