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FORM
Please look at the Instructions and Guidelines
Today's Date:
Your name:
(The name you want to be listed under)
Other names (if any):
(Other names you would like to be listed under.)
Address:
City:
State:
ZIP Code :
Do you want us to display your mailing address (it will not be
displayed unless you type "yes"):
Phone:
Do you want us to display your phone (it will not be displayed
unless you type "yes"):
Email Address:
Do you want us to display your email (it will not be displayed
unless you type "yes"):
Personal Web Site (if you have one):
Organization:
Please list the the organizations you worked with in the South
such as CORE, COFO, MCHR, NAACP, SCLC, SNCC, etc.
Years:
What years were you active in the South?
States:
Which states in the South did work in?
Testimony: (Required.)
What would you like to say? What did you do during the Movement,
what did it mean to you, and what have you been up to since?
Enter your testimony below.
Note Some testimony describing what you did and what it meant to you is required (simply listing the places, years, organizations is not sufficient). You can say whatever you want, but you must say something. (If you wish, you can write your statement with a wordprocessor such as Microsoft Word, and copy/paste it into this email message.)
Enter testimony below:
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