Thank you for your interest in receiving a vest from the St. Michael’s Shield Project. In order for us to send you a vest, we must confirm that you are an active peace officer. You will help us in doing this by answering the questions below. Step 1: Vest Request FormYour Personal InformationFirst & Last Name *Email *Cell Phone *Home Phone Best time to contact you *010203040506070809101112HH000510152025303540455055MMAMPMAM/PMShipping Address (Please do not use a PO Box) *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryYour Agency InformationAgency Name *Agency Phone *Supervisor's Name *Supervisor's Phone *Agency Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryYour IDUpload Your Police Identification * Accepted File Extensions (jpeg, gif, png - 1Mb Max)If you cannot upload your ID, we need you to mail a copy to us: St. Michael’s Shield c/o Vest for Life Inc. 6501 Booher Rd. Corryton, TN 37721Help Us Size Your VestHeight (ft'/in") *Weight (lbs) *Waist Size *Chest Size (in") *Shirt Size *SmallMediumLargeXLargeXXLargeXXXLargeGender *MaleFemaleHold Harmless ReleaseACKNOWLEDGEMENT AND RELEASE The Executive Director of Vest For Life and (vest recipient) have entered into an agreement for the contribution of equipment. Specifically, the Executive Director of Vest For Life has authorized and allowed Vest For Life to donate to recipient certain equipment, namely one (1) used ballistic resistant vest that is not represented or warranted by Vest For Life to meet any standard of quality, design, or suitability for any use. Now, therefore, in consideration of the foregoing, that said undersigned: ____________ does hereby acknowledge receipt and delivery of said equipment and accepts it in its “AS IS, WHERE IS” condition and without warranty of any king, express, or implied, and release, acquit, and forever discharge, hold harmless and agree to indemnify Vest For Life and its agents, servants, and successors from any and all claims for damages, causes of action, demands, rights, damages, cost, expenses, and compensation whatever for and by virtue of the fact that said Vest For Life has conveyed unto the said recipient the said property and items herein described and from any action or conduct of the said recipient, its employees, and agents or end users from which any such damages, causes of action, demands which may arise.Authorization *I have read, I understand and agree to each of the disclosures, authorizations, directions and indemnifications.Your Signature *My typed name above shall have the same force and effect as my written signature.CommentsHow did you hear about the St. Michael’s Shield Project: Additional Comments Vest Shipping DonationPlease note: To facilitate the shipping of your vest, we ask for a $25 donation. This donation goes strictly toward covering the expense of shipping of your vest via UPS.Select Donation Method Once you submit this form, the following page will give you the following 2 options: Donate via PayPal or Mail a Money Order. Please select your $25 donation method here then click the "Submit & Go to Step 2" button to complete your vest request.PayPal DonationMoney Order Donation VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
