Your phone number (with country, city, area codes):

Address:
City/Town:	State/Prov.: Post./Zip Code:
Country:

How extensive is your knowledge of Johnn Eck?  

I saw his show  

I bought art from him  

I was a friend of his  

I worked with him  

I was his neighbor  

I went to school with him  

I had other professional contact with him  

I never met Johnny but have second-hand information  

Other  

What Johnny Eck material can you provide for the documentary?  

I have professional pictures of Johnny  

I have snapshots of Johnny  

I have video or movies of Johnny (not Freaks or Tarzan)  

I have audio tape of Johnny  

I have items associated with Johnny  

I have correspondence with Johnny  

I have other material relating to Johnny

Briefly describe what material or knowledge of Johnny you could contribute to the documentary.

Thank you for your submission. A researcher will be evaluating your application and notifying you about your suitability to participate in the documentary. If you participate, you will be asked to sign a release allowing us to use our recordings of you and/or your material for any purpose relating to the documentary or the Johnny Eck Museum. In exchange for your participation, you will be provided with a free copy of the completed documentary.

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