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Pelican for Patriots – Free Protector Case™ Program (Click here to download brochure)

 Full Name*:    
 Rank: Branch*:
 Address*: City*:
 Province/State*:
Zip/Postal code*:
 Country*: Phone*:
 Fax: Email*:
 
 Where did you serve?
How were you injured?
 Type of prosthesis: Size of prosthesis*:
 
 Contact information of Prosthetist
 Name*: Company*:
 Phone*: Fax:
 Email:  
 
 Find your Case
 Choose a product*:      
 Other: (Please enter catalog number if not available from above)
 Color preference: (OD Green and Silver available on select cases)
 Interior Options:


(Pick N Pluck™ foam and Padded Dividers will ship within 4 to 5 working days.
The custom foam option yields longer lead times of 4 to 6 weeks.)

*Required fields  
 

The following criteria must be met in order to participate in the program:
- Participants in the program must have lost a limb while serving in the United States, Canadian, Australian and British military in support of Operation Iraqi Freedom (OIF) or Operation Enduring Freedom (OEF).