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Please fill out the form completely. If you do not have a copy of your DD214 (retired or separated) or Active Duty Military ID, we will not approve your application. You will also need a copy of your VA Benefits Summary Letter (total percentage). Please do not send your Retired Military ID or your VA ID card.

Mahalo.

* Indicates required field

Name *

First

Last

Age *

Ethnicity *

Other *

Gender *

Birthdate *

Phone *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Service *

Rank *

Length of Services (Yrs) *

Injury or Disability *

Please let us know what your injury or disability is.

Surf *

Level of experience

Types of Equipment Desired *

Surfboard Bodyboard Handplane Prosthetic Wetsuit Other

What conditions do you usually surf? *

Where do you usually surf? *

How often do you surf? *

Why do you need our equipment? I.e., need custom buoyancy, need custom handles, or custom re-enforcement? *

What kind of equipment do you usually use? *

Height *

Weight *

Are you willing to travel to San Diego to surf demo equipment in order to refine the process? If approved and needed, One More Wave will cover the expense *

Yes No

Please feel free to let us know what surfing and surf therapy means to you. *

How did you hear about us? *

Lastly, are you comfortable with taking pictures with your new equipment once it is received? *

Yes No

Please attach your DD 214 or Active Duty ID (No retired Military ID please) *

Max file size: 20MB

Please attach your VA Benefits Summary Letter (No VA ID cards please) *

Max file size: 20MB

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