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US Peace Memorial Foundation

APPLICATION FOR INDIVIDUALS

Being considered for the

US PEACE REGISTRY

Ending the culture of war begins with honoring those who dare to speak out against it. The US Peace Memorial Foundation is the only organization dedicated exclusively to celebrating antiwar heroes—leaders and activists whose example inspires others to work to end U.S. war and militarism. Through our US Peace Registry and the prestigious US Peace Prize, we spotlight these remarkable role models and their vital work.

The specific examples of actions you list below are intended to provide ideas and guidance to others so that antiwar behaviors can be replicated nationwide. The US Peace Registry, including your listing, can be a valuable resource for activists, 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 and militarism, often through nonviolent civil disobedience.

We want this to be a manageable task. Please don’t feel your listing must be comprehensive; include whatever antiwar information is readily available. As funding permits, it is hoped that the US Peace Registry will always be a work in progress, and an approved listing can be updated or revised as needed.

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. We will notify you if you are selected to be honored in the US Peace Registry.

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Email address (will not be published without your permission):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 consent to publish your Email address?

Website and social media links;

Telephone (optional, will not be published):

Describe yourself in one sentence, 30 words or less.

Examples: Jane Doe is a bricklayer working on housing construction in Naples, FL, and a former Navy SEAL. Joan Doe, Ph.D., who lives in Ann Arbor, MI, is a lifelong social justice activist and professor of psychology at the University of Michigan. Jill Doe, a graduate student in International Studies at Stanford University, is passionate about climate change.

List some specific examples of your public antiwar behaviors and activities chronologically from oldest to most recent. We will document your work related to publicly advocating for peaceful solutions to international conflicts involving the U.S. and/or opposing U.S. war(s), militarism, and interventions including invasion, occupation, production and distribution of weapons of mass destruction, use of weapons, threats of war, or other hostile actions that endanger peace. You can view some examples at www.uspeacememorial.org/Individuals.pdf.

Use only one sentence or sentence fragment for each antiwar activity. Give the location, then the date(s), or year(s) at the end of each action. Use behaviorally specific language (e.g., Wrote anti-Iraq war Letter to the Editor, Toledo Blade, 03/07/04). Avoid philosophy, analyses, narratives, and conclusions, and include URLs that will give additional information about you and what you have done to oppose war. Please email Registry@USPeaceMemorial.org if you have any questions or concerns.

Include a digital photo (optional). Please forward a high-resolution digital headshot photo of yourself that we might use in the US Peace Registry, on our website, or in other publications. Usable images are often 1 to 2 MB with a neutral background and no clutter. A close-up smartphone portrait photo sent “actual size” by email will work. The photo must be in the public domain and not require photo credit or attribution.

FOR UNSOLICITED APPLICATIONS ONLY: Unless a representative of the Foundation has asked you to complete this application, please provide at least one form of documentation (evidence) 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, a 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.

I have made the following tax-deductible contribution to the Foundation (A DONATION IS NOT REQUIRED): ___________.

For a limited time, anyone who donates at the $100.00 or higher level will become a Founding Member of the Foundation listed at www.uspeacememorial.org/Donors.htm. Although membership in the Foundation or donating is not a prerequisite to being listed in the US Peace Registry, we ask that you consider supporting the US Peace Memorial Foundation and telling your friends and associates about our website: www.USPeaceMemorial.org. Without your tax-deductible contributions, the US Peace Memorial may never be built.

I certify that the above information is accurate and that the US Peace Memorial Foundation, Inc. has my permission to publish this information if I am chosen to be honored 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'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 the next 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 and photo(s) constitutes permission to publish the information and photo(s) in print, electronic, or other formats.

Signature: _____________________________________________ Date: ______________

Please sign and email your completed application to Registry@USPeaceMemorial.org.

Or 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.