Contact and Information Request Form
Please fill in the information below so that we can provide you with any information you may request of if you just wish to identify yourself as a supporter of our cause. Just fill in the blanks that you are comfortable with -- none are absolutely required except your name and some way to contact you. All information will be considered private and will not be voluntarily released to other parties without your permission.

Application for F.E.A.R. Information and Contact

Name:  Title: 
Organization:

Check if applicable: Member Victim    
                                  Lawyer  Volunteer

Address: (Is it Business or Home ?)
Street:  Suite/Apt#: 
City:  State: 
Country:  Zip/Postal Code: 
Telephone (include long distance & overseas prefixes):  Fax number: 
Email address:  Website: 
Background
Occupation/past occupations: 
Education, degrees, specialties 
Requests (Check all that apply)

FEAR Brochures:       You would like to be called: About what?
Add you to Email FEAR-List:          Add you to Email FEAR-Talk List:
You want info on: Forfeiture Defense Manual   Other Merchandise:   Membership:   Contributing

Use this space to add any comments, questions, alternate phone/address/email for calling/mailing of information, etc. 
Suggestions for improvement of web pages, references to useful information, etc.

Once you have completed this form and read it over for accuracy, press Submit. We will do our best to respond to you right away.

[Created 11/11/02]