Please fill out the form below 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.

Mahalo.

Name

Phone

Address

Zipcode

State

Email

Service

Rank

Length of Services (yrs)

Injury or Disability

Please let us know what your injury or disability is.

Surf

Level of experience

Type of Equipment Desired

SurfboardBodyBoardHandplaneProstheticWetsuitOther

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

YesNo

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?

YesNo

Please attach your DD 214 or photographic ID