Submit Your Story

Use this form to submit your story and your photo for us to post on Kids in Birmingham 1963 Web site and to tell us a little about yourself. Items marked * are required.

Name *

Your Email *

(We need this to confirm your story, but will not share it with anyone else)

Phone Number

Location. Where do you live now?

City *

State *

Country

Your age in 1963 *

School you attended in Spring 1963

School you attended in Fall 1963

Did you live in Birmingham in 1963? *
 Yes No

Type or paste your story here

Or, upload your story here: (PDF/Word)

Type or paste your bio here

Or, upload your bio here: (PDF/Word)

STORY RELEASE: * I grant permission to Kids in Birmingham 1963 to post all or part of my story on the Web site. I understand that Kids in Birmingham 1963 is not for profit. I understand that Kids in Birmingham 1963 will use my story only in the ways I have indicated here. Since information on the Internet is available to all, I understand that no one associated with Kids in Birmingham 1963 can be held responsible for how others might use materials on the Web site.
 Yes

Has your story been published elsewhere?
 Yes No

If yes, where and when was it published?

PHOTO RELEASE. * I grant permission to Kids in Birmingham 1963 to post the photo(s) I provide on the Web site. I understand that Kids in Birmingham 1963 will use my photo(s) only in the ways I have indicated. Since information on the Internet is available to all, I understand that no one associated with Kids in Birmingham 1963 can be held responsible for how others might use materials on the Web site.
 Yes No

Upload your photo here: (jpg,jpeg,png,gif) (5MB max size)
if you have trouble uploading a photo, email to kidsinbirmingham1963@gmail.com

PROMOTION. I grant permission to Kids in Birmingham 1963 to use all or part of my story and photo(s) in print or on the Internet in materials to promote the use of this Web site.
 Yes No

RECEIVE INQUIRIES FROM THE MEDIA. I grant the managers of Kids in Birmingham 1963 permission to contact me about inquiries from reporters, historians, and others. I can choose whether to talk with anyone about my experiences in Birmingham. The managers will not send my contact information to anyone without my permission. I can stop receiving these inquiries at any time by sending an email to kidsinbirmingham1963@gmail.com with STOP in the subject line. To learn about talking with the media and others, click here.
 Yes No

TELL ME WHEN MY STORY IS POSTED. Please e-mail me when my story appears on the site.
 Yes No

kidsingbirmingham1963.org is not for profit. We will use your story only in the ways you have indicated, above. The Web site cannot be held liable for uses that may be made by others of material posted on this Web site.