US Peace Memorial Foundation
APPLICATION FOR INDIVIDUALS
TO BE LISTED IN THE
The US Peace Memorial Foundation directs a nationwide effort to honor Americans who stand for peace by publishing the US Peace Registry, awarding an annual Peace Prize, and planning for the US Peace Memorial in Washington, DC. These educational projects help move the United States toward a culture of peace, as we honor the millions of thoughtful and courageous Americans and U.S. organizations that have taken a public stand against one or more U.S. wars or who have devoted their time, energy, and other resources to finding peaceful solutions to international conflicts. We celebrate these role models to inspire other Americans to speak out against war and to work for peace. For more details, please read the short commentary “World Peace: A First Step” at www.uspeacememorial.org/WorldPeace.htm.
To be considered for the US Peace Registry, please provide the following information about yourself:
Copy this form into an email or Word document and send the completed form to Registry@USPeaceMemorial.org. If you also represent an antiwar organization that should be included in the Registry, please complete the application at www.uspeacememorial.org/Organization.htm
Name (and highest degree if you wish listed):
Complete Mailing Address (only city and state will be published):
Do we have your permission to publish your city name?
Email address (will not be published without your permission):
Do we have your permission to publish your Email address?
Telephone (optional, will not be published):
Describe yourself in 30 words or less.
Examples: James Doe is a bricklayer working on housing construction in Naples, FL and a former Navy SEAL. Joan Doe, Ph.D. is a retired University of Michigan biology professor living in Detroit, MI. Jill Doe is a graduate student in International Studies at Stanford University. Jeff Doe stays at home with his two young sons in Austin, TX and volunteers for Habitat for Humanity.
List some specific examples of your public antiwar/peace behaviors and activities in chronological order from oldest to most recent. The actions/behaviors listed under each record are intended to provide ideas and guidance for current and future generations.
Use only one sentence or sentence fragment for each antiwar activity. Give the location, then date(s) or years at the end of each activity. Do not include your name again. Use behaviorally specific language (e.g., Wrote anti Iraq war Letter to the Editor, published in the Toledo Blade, 3/7/04). Avoid analyses and conclusions and feel free to include URLs that will give additional information. Review examples at www.uspeacememorial.org/Registry.htm.
We do not want this to become an onerous task or for you to feel that your listing must be comprehensive. Just include whatever information is readily available to you or a sampling of your actions. Additional action/behaviors can be included at a later date. The US Peace Registry will always be a work in progress and a listing can be updated or revised at any time. Please understand that the US Peace Memorial Foundation does not have the resources (volunteers) to extract the necessary information from narratives, websites, or C.Vs.
Unless you have been asked by a representative of the Foundation to complete this application, please provide at least one form of documentation (evidence) clearly linking you to a specific antiwar/peace activity for every five entries you list. At least one piece of evidence must be included with short entries. Examples of documentation may include a publication reference, peace/antiwar website reference to you, letter to the editor showing the name of the publication and date; a letter from a congressional representative acknowledging your antiwar position, a newspaper article mentioning you and your activity, etc. Include URLs if they are available.
INCLUDE DIGITAL PHOTO (optional). When the US Peace Registry is published as a book in 2017, it may be possible to include a photo of the individuals listed. Please send us a digital photo of yourself if you have one.
I have made the following tax deductible contribution to the Foundation (DONATION NOT REQUIRED): ___________
I certify that the above information is accurate and that US Peace Memorial Foundation, Inc. has my permission to publish the above information in the US Peace Registry. I understand that the Foundation will not sell or rent my name and personal information to any other organization.
It is understood and agreed that the editors reserve the right to select material consistent with the US Peace Registry style and space limitations. In the event of errors, the sole responsibility of the US Peace Memorial Foundation, Inc. will be to correct such errors in a succeeding edition of the publication. Such correction of errors is in lieu of any other legal remedy and the Foundation expressly disclaims all other liability for loss or incidental or consequential damage whether arising from negligence or any other causes. Submission of information by the named individual, or their representative, constitutes permission to publish the information in print, electronic, or other formats.
Signature: _____________________________________________ Date: ______________
Please email your completed application to: Registry@USPeaceMemorial.org.
Also, please mail your documentation, a signed copy of this form, and any donation to:
US Peace Memorial Foundation • 334 East Lake Road #136 • Palm Harbor, FL 34685
US Peace Memorial Foundation, Inc. is a tax-exempt 501(c)(3) public charity.
Donations to the Foundation are tax deductible to the extent provided by law.
Florida registration #: CH20094. A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE FLORIDA DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE (800-435-7352) WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE.
Copyright 2005-2017, US Peace Memorial Foundation, Inc.