US Peace Memorial Foundation
APPLICATION FOR INDIVIDUALS
TO BE LISTED IN THE
The US Peace Memorial Foundation honors Americans who stand for peace by publishing the , awarding the , and fundraising for the in Washington, DC. We recognize thoughtful and courageous Americans and U.S. organizations that have taken a public stand against one or more U.S. wars or 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 details on our progress, read our .
The specific examples of actions you list below are intended to provide ideas and guidance to others so that peace/antiwar behaviors can be replicated nationwide. This will help people feel more comfortable speaking out and lead to greater citizen involvement in antiwar activities. The , including your listing, can be a valuable resource for peace scholars and practitioners engaged in research, teaching, action, and organization building. Americans who have written an antiwar letter to their representatives in Congress or published a Letter to the Editor are included, along with those who have devoted their lives to peace and opposing war, often through civil disobedience.
We look forward to reading about all that you have done to end wars. Feel free to email if you have any questions or concerns.
We do not want this to become an onerous task, or for you to feel that your listing must be comprehensive. Just include whatever antiwar information is readily available to you. You can send more details later to add additional actions to your listing. The will always be a work in progress, and a listing can be updated or revised at any time.
To be considered for the , please provide the following information about yourself:
Copy this form into an email or Word document and send the completed form to . We will notify you if you are selected to be honored in the
Name (and highest degree if you wish to have it 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Email address (will not be published without your permission):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?
If you wish for us to add a link to your website, Facebook, Twitter, or other social media, please provide the URLs.
Telephone (optional, will not be published):
Describe yourself in 30 words or less.
Examples: Joan Doe, Ph.D., who lives in Ann Arbor, MI, is a life-long social justice activist who is a Professor of Psychology at the University of Michigan. James Doe is a bricklayer working on housing construction in Naples, FL, and a former Navy SEAL. Jill Doe, a graduate student in International Studies at Stanford University, is passionate about climate change. 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. You must give the location, then the date(s), or year(s) at the end of each action. 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, 03/07/04). Avoid analyses and conclusions, and feel free to include URLs that will give additional information about you and what you have done to oppose war. Review examples at .
Please understand that the US Peace Memorial Foundation does not have the resources (volunteers) to extract the necessary information from narratives, websites, or CVs.
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. URLs are sufficient if they are available.
INCLUDE DIGITAL PHOTO (optional). We hope to be able to add some photographs. Please forward a high-resolution digital headshot photo of yourself that we may use in the Registry, our website, social media, and perhaps in a book. Note: Usable images are often in the range of 1 to 2 MB. A smartphone portrait photo sent "actual size" by email should work.
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. 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's style and space limitations. In the event of errors, the sole responsibility of the US Peace Memorial Foundation, Inc. will be to correct such inaccuracies 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, photo(s), or graphics by the named individual, or their representative, constitutes permission to publish the information, photo(s), or graphics in print, electronic, or other formats.
Signature: _____________________________________________ Date: ______________
Please sign and email your completed application to .
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 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.
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