Religious freedom support for Wiccans, Pagans, and other Nature religions practitioners worldwide. An international information and networking service sponsored by: Circle Sanctuary PO Box 9 Barneveld, WI 53507, USA Email: liberty@circlesanctuary.org Phone: (608) 924-2216 Fax: (608) 924-5961

Lady Liberty League Help Request Application
In an effort to expedite your request, we have provided this online form. Please complete all fields in it and use the Submit button at the bottom of the form to send it to the appropriate LLL staff. The more thorough your answers are, the more we might be able to help you or direct you to helpful resources. Also, please do not respond in all caps. This will help our staff to easily read your information. Thank you.

Your E-mail Address:
Full legal name(s) of person(s) seeking help:
Postal Address with Zip:
Home Telephone Number:
Best days and times to call:
OK to call collect regarding inquiry?	Yes No
Fax Number (if applicable):
Personal spiritual name, nickname, or other name(s) (if applicable):
Name & contact info of any associated group, festival, etc. (if applicable):
URL of associated personal and/or group websites (if applicable):	1. 2.
Name and contact information of person making inquiry on behalf of person seeking help, if different from above. Be sure to include email, if available.
Name and contact information for your attorney(s) and/or other advocates, if any. Be sure to include email, if available, and indicate role or relationship to you and your situation.
Attorney 1 Name:
Address:
Email:
Phone:
Fax:
Relationship:
Attorney 2 Name:
Address:
Email:
Phone:
Fax:
Relationship:
Situation Details:
How did you come to contact LLL?
Specifically what kind of contacts and other help do you seek from LLL?
What other individuals and/or organizations have you asked to help you and what has been the response thus far?
Describe in detail what has happened. Include a chronology of the situation, with dates, names of individuals involved, locations, actions.
Specifically document and detail why you think that you are being discriminated against and/or harassed on the basis of your religion. Submit copies of any documents that substantiate discrimination.
Please provide a brief description of your religious/spiritual tradition or path:
Name of tradition:
Years practicing:
Group affiliation, if any:
Name of an Elder, Teacher, or Author whose path is same/similar:
Name, phone number and/or email of mentor or co-practitioner who can be contacted for more information about you and your practices:
Description of your beliefs and practices:
Networking Help Options: After receiving your completed request and considering it, if we think one or more people affiliated with LLL may be able to help you, we may network on your behalf using one or more of the methods described below. Please activate the checkbox at left of each question below if you are willing for us to use that method.
Give your contact info for one or more LLL specialists and/or other volunteers who may be able to help you.
Consult with specialist(s) on LLL task force(s).
Email LLL's activists networking list with news of your case and the forms of help you seek.
Post details about your case and the help you seek on LLL webpage
Ask other groups that network with LLL to post info on their websites and/or pass on requests for help through electronic mailings lists.
Publish information about your case in the online LLL Report.
Verification code: