Personal Histories
                                    from Video Edge 
Contact Us                                         816-987-2133
Survey and Contact Information

Answer the two questions below and then tell us a little about yourself.


What do you remember about your parents or grandparents? Check all that apply.



  The way they told stories at family gatherings


  Their favorite sayings


  Their laughter


  Their philosophy of life


  How important you and family are or were to them








What would you like your children or grandchildren to have or remember about you? Check all that apply.



  The photos that tell my story from MY perspective


  The sound of my voice or my laughter


  My facial expressions when I tell a story


  How I use my hands when I tell a story


  My favorite sayings


  Other:








Contact Information



First Name:


Last Name: *


Address Street 1:


Address Street 2:


City: *


Zip Code: * (5 digits)


State: *


Daytime Phone:


Evening Phone:


Email: *


Comments:


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