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Selma, AL Registration Form


Please register below for the 50th Anniversary of "Bloody Sunday, March 7, 1965 Selma, AL" bus trip on March 8, 2015.
Then click on the Donate button to make your online payment.

Organization/Group name:
First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code: (5 digits)
State:
Daytime Phone:
Evening Phone:
Email:
If the name on the credit card used is NOT your name,
please provide the card holders name for verification purposes:
Comments: