Testifier Registration Form

Names Recovery Campaign: In Partnership with Yad Vashem

Please fill out this form and send it to (add contact details)

I would like to bear witness for one or more victims of the Shoah by filling out Pages of Testimony that will be submitted to Yad Vashem.

First name: ______________________________________________________________

Last Name: ______________________________________________________________

Street: _________________________________________________________________

City, state, zip: ___________________________

Phone: __________________________________

Fax: ____________________________________

Email: __________________________________________________________________

Preferred languages:

Check one:

Please send me Pages of Testimony to fill out and return by mail

Please send someone to help me fill out Pages of Testimony

Other – specify: