Patria Soli | Sender Form

Sender Form

Your Name:

Email Address:

Mailing Address: (this is where we send a package to)

Location where your soil is from: (you can say "same" if it is the same as your mailing address)

Are you responding to our "Instagram Call," sending soil for "Anyone," or sending it to a "Particular Receiver"?

Instgram Call

Anyone

Particular Receiver

If you are sending soil for "Instagram Call" or to "Anyone," are you ok with providing your name and email address to the receiver?

Your Info to receiver?

Yes

If you answered "Particular Receiver" above, please provide us the person's name, email address, and mailing address. (Also, please tell us if you are not able to collect soil because you are wanting to send soil from somewhere else rather than where you live. You can indicate it in "Location" above or here.)

If you are sending soil to "Particular Receiver," are you also interested in our help for the end of life conversations with the person?

End of Life?

Yes

Would it be ok with you if your name (first name only) and location appear in our photographs, website, and artwork?

I agree with Patria Soli to use my first name and location in their documentations and artworks.

Please do not use my name and location in any documatations. (Please understand that your name and location appear on the bottle of your receiver)

If you have any other comments, please put them here. If you would like to add a message to a receiver of your soil, please write it here too. We would also love to hear your story or thoughts on homeland, soil, and/or your memories if you would like to share them.

Thanks for perticipaton!