In Take Form | America First

Tell Us About Your Experiance

Tell us about your situation that resulted in you being identified as a J6er. We want to hear your story and we will be reaching out to you regarding next steps.

First name

Last name

Phone number

Email

Have you in the past or are you currently subject to political persecution and/or prosecution, and did it result in incarceration? (Provide as much detail as possible including dates, places, and persons involved.)

If you answered yes to the above question did you receive a pardon or not?

Are you managing a J6 organazation? and if so please provide us with the name of the organazation, and list the website URL and any social media handles your organization is registered with. (If you are not then type N/A in the text box)