About You and your Request
Nature of Request
*
For example: advice & counsel, representation, networking, court action, etc.
Urgency of Request
*
Provide deadlines, dates etc.
Your full LEGAL name
*
Your Street Address
*
Your City / State / ZIP
*
Your Email Address
*
Your Phone
*
Best Days / Times to Call
*
Your Spiritual Name, Nickname or other name(s), if any
About Your Religious Tradition / Path
Name of Tradition / Path
Years practicing
Group affiliation (if any)
Name of Elder, Teacher or Author on a similar path
Name & phone/email or a mentor or co-practitioner who can be contacted for more information
Describe your beliefs & practices
*
Group or Festival You Associate With
Name
Address
Phone
Fax (if any)
Email
Your Relationship to Group/Festival
Group/Festival Website URL
Your Attorney or Advocate (if any)
Name
Address
Phone
Fax
Email
Others Involved or Assisting
Name
Address
Phone
Email
About Your Situation
Describe in detail what has happened. Include dates (in chronological order), names of individuals involved, locations, actions, etc.
Explain, in detail, why you think that you are being discriminated against and/or harassed on the basis of your religion.
Specifically what kind of contacts or assistance do you seek from LLL?
How did you come to contact LLL? How did you hear about us?
What other individuals and/or organizations have you asked to help you and what has been the response thus far?
Networking Help Options
Upon receiving your completed request, and after considering it, we will determine if we are able to help you. We may network on your behalf using one or more of the methods described below. Please check any methods that you are willing for us to use.
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Give your contact info to LLL specialists and/or other volunteers who may be able to help you.
Yes
Post details about case and the help you receive on the LLL web page
Yes
Call out for assistance via LLL’s social media (Facebook, Twitter)
Yes
Ask other groups that network with LLL to post info on their websites and/or mailing lists
Yes
Is there anything else you'd like to tell us?
I certify that the information provided above is true and complete to my knowledge.
*
Yes
Please trace the figure to the right, to prove you're a real person.
*
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