Herstory Meeting House Questionnaire
* First Name(s)/initials:
NOT SHOWN
* Last Name:
NOT SHOWN
How did you learn of the Herstory Meeting House (from which publication or other source)?
NOT SHOWN
* Email Address (please enter carefully):
NOT SHOWN
Alternate Email Address:
NOT SHOWN
* Phone Number:
NOT SHOWN
Postal Address:
NOT SHOWN
State/Province/Territory/Region
(for members in the USA, Canada or Australia)
:
NOT SHOWN
* Country:
Show country with flag?
Yes
No
For other countries: County/State/Territory/etc.:
NOT SHOWN
Chief interests in history:
History in general
American
World
Lesbian
Women's
Social/Popular
Sex/Gender studies
Human impact on environment
Religion/Beliefs studies
Military (includes wars)
Political
Memory/Memorials/Monuments
Historiography/Historicity
Anthropology/Archaeology
Medical
Science/Technology
Labor
Regional/Local
Geography/Cartography
Agriculture/Farming
Cultural/Ethnic studies
If your interests in history are not listed above, include them here:
Are you, have you been, or do you expect to be professionally involved in history interpretation (e.g. teaching, volunteering, site interpreting, writing)?
Yes
No
University degree(s) attained
(indicate below at "education" what you want shown)
:
none
currently in undergraduate program
Bachelor's
Master's
Doctorate
advanced medical
advanced business
advanced law
other
Current relationship status:
Attached
Unattached
Other (complicated)
Show relationship status?
Yes
No
Identify as:
Lesbian
Straight
Bisexual
Transgendered
I defy categorization
Show identification?
Yes
No
Belief System
(indicate below at "belief system" what you want shown)
:
decline to answer
agnostic
atheist
deist
spiritual
Buddhist
Baha'i
Christian-Roman Catholic
Christian-Orthodox
Christian-Protestant
Christian-Evangelical
Christian
Christian background, non-practicing
Hindu
Humanist
Jewish
Jewish-Orthodox
Jewish-Reform
Jewish-Secular, non-religious
Muslim
Muslim-Specific
Pagan
Pantheist
Quaker
Rastafari
Taoist
Lukumi/Santerian
Unitarian
questioning/undecided
other
If your particular belief system is not listed, or if you'd like to add a descriptor to a category listed above, include it here
(if used, indicate below at "belief system" what you want shown)
:
Name
(the name other members will see)
:
(online ID, nickname, true name, whatever)
Current Location:
(can be region or something vague ... just not as vague as "Earth" or "Northern Hemisphere")
Birth Year/Age:
Education:
Occupation:
Belief System:
Particular interests in history, current passions:
If you could live in a different time period, when would that be? Why?
If you could meet an historical figure (living or dead), who would it be and why? What questions would you ask them?
What lessons from history do you wish people would finally learn so as not to repeat the same mistakes?
What historical sites (or museums) have you visited that are your favorites and why?
What places in the world (both historical and not) would you like to visit?
Other interests and pastimes:
Preferred reading material or information sources, favorite books/writers/films, tastes in music, favorite artists/art forms, tastes in food:
What movies do you think do a good job in portraying a certain time period?
What is the most recent history topic which you learned something new about?
Additional comments (e.g. goals in life, political leanings, soapbox issues, things you'd like to do with history--websites, write books, teach, become an historical interpretor at a site, whatever, etc.):
Capsule Comment: This will be your introductory remarks to other members and can be a single phrase, your favorite quotation, a greeting, or something longer.
Note that you needn't repeat info given in answers to questions, such as your age, occupation, location.
* If you are ready to submit your application AND you agree to the House's rules and regulations, please enter your name here:
Would you like your profile added to the example page
(one seen by the public)
?
Yes
No
Sending a photo?
(so I know to watch for it at
herstorymeet@verizon.net
)
Yes
No
(online ID, nickname, true name, whatever)
