--: Survey - September 15 Mass Die-In/Funeral

September 15 Mass Die-In/Funeral

I will participate
in the mass
Die-In/Funeral

Sat, Sept 15
in Washington DC

*1.

Question - Required - I will participate in the Die-In/Funeral on Saturday, September 15 in Washington DC. I am ready to commit to participating in this civil disobedience action which may risk arrest.
I am interested in this action. Please contact me to discuss it further.

2.

Please complete the following:

*

Name:

First Required	Last Required

*

Email: Required

Street 1:

*

City/State/ZIP:

City Required	State Required	ZIP Required

Country:

*

Phone Number: Required

If you respond and have not already registered, you will receive periodic updates and communications from PEP.

3.

Question - Not Required - Cell phone:

4.

Question - Not Required - Work phone:

5.

Question - Not Required - Fax:

6.

Question - Not Required - Organization / School / Union (please write out all acronyms)

X
Please read this important note:

If you are participating in the Die-In/Funeral and feel compelled to select the name of one of the almost 4,000 soldiers who have been killed in Iraq, you are encouraged to do so. You can select a family member, friend or someone from your city, town or state. Please bring a photograph of that person and a sign with his/her name on September 15.

There will also be a dramatic representation of Iraqi war dead. Many demonstrators are choosing to select the name of an Iraqi citizen who has lost their life in this unjust war. At a minimum, hundreds of thousands of Iraqis have been killed.

Click here for a list of U.S. soldiers.
Click here for a list of Iraqi people.
(The links will open a separate window so you can continue to fill out the form.)
x

7.

Question - Not Required - This is who I will lie down for (see explanation above):

(Maximum response 255 chars, approx. 5 rows of text)

X
Message to participants:

There will be information packets about logistics and legal Know Your Rights information sent to all those participating. The National Lawyers Guild Mass Defense Committee and the Partnership for Civil Justice will be providing legal support for the demonstration.
x

8.

Question - Not Required - Message to organizers:

(Maximum response 255 chars, approx. 5 rows of text)