Family Member Registration Form Registration Options If you are a member of a veteran's immediate family, you are eligible to become a 360VA Family Member. Create Profile First Name * Last Name * Email Address * Username (lowercase alphanumeric) * Password (type this twice please) * password strength indicator Additional Info Member Category * 360 Leader Member (Leader 360 Course Alumni)360VA Member (Military Veteran)Family Member (Spouse/Partner of Military Veteran) Family Member, please provide the name and service information for your veteran. Name of Veteran Current Military or Government Civilian Status * Active Duty Retired Military Former Military Active Government Civilian Current or Last Rank Held * E-3E-4E-5E-6E-7E-8E-9WO1CW2CW3CW4CW5O-1O-2O-3O-4O-5O-6O-7O-8O-9O-10GS-5GS-6GS-7GS-8GS-9GS-10GS-11GS-12GS-13GS-14GS-15 Service * Army Navy Air Force Marines Coast Guard (ROTC/Service Academy) Period of Service Began MM/YYYY * Period of Service Ended (MM/YYYY or blank if still active.) Please enter your phone number and mailing address. This information will NOT appear on your 360VA member profile. Phone Number (###-###-####) Current Street Address City State (Ex. VA) Zip Code Home of Record. Again, this information will not appear on your 360VA member profile. City State (Ex. VA) Security Verification Complete Registration Submit Form
