Add Yourself to the Veterans List

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  1. Use your cursor to select (highlight) the form below.
  2. Click on this email address to bring up an email window.

  3. Paste the contents of the copies form into the email window.

  4. Enter your answers to the form questions in the email window and then send the email



Please look at the Instructions and Guidelines

Please answer the following questions:

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.)

ZIP Code :
Do you want us to display your mailing address (it will not be displayed unless you type "yes"):

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):

Please list the the organizations you worked with in the South such as CORE, COFO, MCHR, NAACP, SCLC, SNCC, etc.

What years were you active in the South?

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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