Become a Member Please complete this Registration Form apply for membership and gain access to the Members Only portion of 360VA.org Registration Options 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) Are you a graduate of a 360° Leaders Course * Yes No 360° Course Location & Date (MM/YYYY) 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