Dover to D.C. Memorial Procession

Sunday, March 14 - Monday, March 15, 2004

[walking and bus/van/car caravan]

A Trail of Mourning & Truth - Nonviolent Civil Disobedience @The White House

Philadelphia Area Contingent Form

NAME: _______ _______________

ADDRESS/TOWN/STATE/ZIP:________ _________________________________

PHONE: _______________________ (day); _______________________(evening)

E-mail:_

I will be participating in the Dover - DC Memorial Procession: A Trail of Mourning & Truth on:

( )*both days._

( )*March 14 (only, the estimated length of the day's walking is 3.5 miles).___

(__ )*March 15 (only, the estimated length of the day's walking is 5 miles).

( ) I plan to be part of the bus/van/car caravan from Dover - DC. Sleep-over (sleeping bag floor) space will be provided as well as dinner and lunch. Do you have special needs (i.e. would you need a bed in a private home)?

I can: ( ) provide and ( ) drive my: ( ) van [holding _ people]; or ( ) car [holding people].

( ) I plan to participate in the nonviolent civil disobedience @The White House and be part of the Phila. Area Affinity Group for the civil disobedience.

I will publicize the March 14 - 15: where and in what way?:

I can provide or work on?:

Questions, Concerns, Ideas:

Enclosed is a contribution of $_____ to help with expenses of the Phila. Area Contingent for the Dover - DC Memorial Process: A Trail of Mourning & Truth. Make checks payable and return to:

Brandywine Peace Community

P.O. Box 81, Swarthmore, PA 19081 - 610-544-1818

brandywine@juno.com www.brandywinepeace.com