B(L)ACK in San Francisco Story Collection Form

This form is a space for us to learn about you and your experience.
There are a few questions, mostly in regards to contact information, demographic details and of course your story.

The stories can be in the form of memories, reflections or a mix of the two. All in All, we are interested in hearing the dynamic experiences of Black creatives in San Francisco.

Select stories will be added to our podcast and our website.
All of the collected stories will be added to the projects archive.

We thank you for contributing to B(L)ACK in San Francisco & bringing back the narrative of Black creativity to the city.
Name*

First NameLast Name
Email*
example@example.com / This will be our primary form of contact
Phone Number
Please enter a valid phone number. This is optional and or second form of contact
What is Your Connection to San Francisco*

Born & RaisedLivedWorkedWent to SchoolWould VisitOther
Please Share A Brief Bio About Yourself*
Please Describe Your Creative Practice
How do you identify?
Racially / Ethnically / Gender / Sexuality ect.
Your Age*

78 & older77 - 5958 - 4241 - 2726 - 1110 & Yonger
As mentioned, what you share can be a memory or a reflection; about your experience as a Black creative in San Francisco or an experience you had as a Black creative in San Francisco. While we are reaching out to folks that identify as Black creatives; this story can be about anything you are open to share; community, love, beginnings, endings, transformation ect. The mic is yours
Your story is about....*

an art show/exhibitionbeginningsblack businesses in san francisco (past or present)black joycareercomedycoming of agecommunityendingsfamilyfriendshipgendergriefhistoryhousingloveparenthood / guardianshipa performanceneighborhoodschoolsexuality / sexual identitysocial justicespiritualitytransformationOther
Below is the option to share you story in audio, video or written format.

When recording your story please be in a quiet space without loud distracting sounds ex. people talking in the background / music ect.

Because there is a 7 minute time limit on the stories collected we recommend thinking about your story ahead of time. Please use miked headphones if possible.
Share Your Story Here
If you would prefer to write your out your story please leave it here.
What neighborhood(s) in San Francisco does your story take place? *
Submit A Picture of Yourself (or Pictures Connected to The Story You Shared)
Thank You Again for Contributing to B(L)ACK in Francisco
Content Usage Agreement / Consent Form

B(L)ACK in San Francisco would like your permission to use the images, audio, video and/or written words that you have submitted for the project. This content will be published in both digital and print formats and may be used within the project B(L)ACK in San Francisco and all of its promotional materials including but not limited to : art installations, fliers/posters, website, podcast, videos, zine, social media platforms and the B(L)ACK in San Francisco digital archive.
I blanks* (name) grant permission for images, audio, video and/or written words of me to be used in the formats indicated above. I blank
blank (name), agree and understand that by signing the Electronic Signature Acknowledgement and Consent Form, that all electronic signatures are the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement.
Signature*

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Thank You Again for Contributing to B(L)ACK in Francisco