Registration Form with E-Signature

1
Are you at least 18 years old?
Please Select
Please Select
Yes
No
2
Are you African American?
Please Select
Please Select
Yes
No
3
Are you a direct descendant of a Negro ancestor who was affected before, during, and/or after the 1921 Tulsa Massacre?
Please Select
Please Select
Yes
No
4
Are you willing to share stories of your ancestors' resilient involvement?
Please Select
Please Select
Yes
No
5
Are you willing to participate in an individual interview lasting 60 minutes or longer?
Please Select
Please Select
Yes
No
6
Name
First Name
Last Name
7
E-mail
example@example.com
8
Telephone number
example@example.com
9
Signature
10
Comments
Should be Empty: