21 Day Habit Change Check in Form

Sequoia Park Memories Submission

Thank you so much for taking part in this important and fun project! Please use this form to give us your memories and/or photos to be used in our collector's issue publication.If you prefer, you can send your memories to sequoiaparkmemories@ci.eureka.gov. The information you provide will only be used for this project. We will not sell, rent, or in any other way, give out your information. We respect your privacy. Should you have questions or run into problems, please contact Scott "Q" Marcus, Eureka Community Services Media Coordinator, at 707.440.9271 or smarcus@ci.eureka.ca.gov. (Fields marked with an asterisk "*" are required fields.)
What is your name please?*

First Name*Last Name*
Where did you hear about this website please?*
What is your email address?*
You can do three things on this site:
- Upload a written or photo memory for the City to use
- Tell us what Sequoia Park has meant or does currently mean to you
- Both
Please answer the following questions and the form will adjust to what you select. If you have questions, please call Scott "Q" Marcus at 707.440.9271 or send an email to him at smarcus@ci.eureka.ca.gov

Please continue to the next page.

Would you like to tell us what Sequoia Park has meant to you or what it does mean?

YesNo thank you.
What does Sequoia Park mean to you - or what has it meant?
Please be aware we may use what you say here in our publicity. You are therefore giving us permission to do so by answering this question. Thank you.
Would you be willing to be interviewed by a representative of the City about your comments?

YesNo
Thank you. We need to know how to contact you.
How would you be willing to be interviewed?

PhoneZoomEither

Do you want to submit a memory?

Yes, written.Yes, a photo.Yes, both.No thank you.
Please provide a favorite memory of Sequoia Park.
This might be included in the publication. We will notify you if it is chosen. Unless you specify otherwise, we will give you credit.
Please give us a description of the image(s) you are uploading.
This might be included in the publication. We will notify you if it is chosen. Unless you specify otherwise, we will give you credit.
If you are unclear how to upload a photo or you require assistance in scanning, please contact Scott "Q" Marcus, Media Coordinator at 707.440.9271 or send an email to sequoiaparkmemories@ci.eureka.ca.gov
Please upload your image here

Click here to upload your image(s)

Cancelof

Would you like someone to reach out to you about your submission?

YesNo
Your Phone Number
Optional
Please leave any additional comments in this box.
If you'd like to leave a comment, this is the place to do so.
Do you wish to have that email address added to our e-mailing list so you can be kept aware of this project?*

YesNo
What's the best way to contact you?

Email Address (above)Phone number (above)Other (please specify; field will appear below)
How should we contact you?
This is how we will reach out to you about our comments.
IMPORTANT:

By submitting on this form, you give the City of Eureka the authority to utilize what you provide for this and any related projects related to Sequoia Park memories and also allow the City and any designated agents to use it in publicity.

You also attest to the fact that you are 18 or older and have the authority to submit these materials to the City.
By checking this box you agree to the terms of usage (as above).*

I agree
Please verify that you are human*
Should be Empty:

Sequoia Park Memories Submission