Fact Not Fiction Campaign Survey

Thank you for letting us know that you plan to join the "Fact Not Fiction" Campaign.

Please take a few minutes to fill out this form and help us keep track of and support congregations and individuals across the country who are participating in the campaign.

If you have any technical problems in completing this form, please contact Paz Artaza-Regan, NRCAT's Director for Program & Outreach, at partaza-regan@nrcat.org or 202-547-1920.

1.Your Information:(Required.)

Your Name:

Your Phone #:

Your E-mail:

Congregation or group:

Faith group/denomination:

City:

State:

Zip Code:

2.I will join the "Facts Not Fiction" campaign in these ways:

I will organize a screening of "Ending U.S.-Sponsored Torture Forever" - NRCAT will send you more information

I will distribute leaflets at local theaters sharing the facts about torture with people who are going to watch "Zero Dark Thirty" - Download leaflet at www.nrcat.org/fact-not-fiction

I will write a letter to the editor - NRCAT will send you talking points

Other (please specify)

3.If you are doing a screening of NRCAT's video and would like NRCAT to list the event on its website please share details of the event now or email Paz at partaza-regan@nrcat.org.

Thank you again for joining our "Fact Not Fiction" Campaign.

If you have any questions or concerns, please contact Paz Artaza-Regan at partaza-regan@nrcat.org.

National Religious Campaign Against Torture
110 Maryland Ave. NE, Suite 502
Washington, DC 20002
202-547-1920