Brownsburg Public Library Registration

Survivor Speakout Victim Impact Panel at the Brownsburg Public Library
450 S Jefferson Street, Brownsburg, Indiana 46112

THE LIBRARY PANEL IS IN ENGLISH ONLY. Register to attend by completing the form below. Space is limited. You must provide true and accurate information when you register. You will be considered a “No Show” if you are late or fail to attend the date you chose to attend. You must reschedule and pay an additional fee if you are a no show for any reason. There are NO REFUNDS.

DATES AVAILABLE
All Live In-Person Victim Impact Panels are from 9:45 A.M. to 12:00 P.M. EDT (Eastern Daylight Time). Arrive by 9:30 A.M.

Saturday, August 16, 2025
Saturday, September 27, 2025
Saturday, October 18, 2025
Saturday, November 15, 2025

REGISTER TO ATTEND

The form below is to request to attend Survivor Speakout Victim Impact Panel IN PERSON. Once the form has been submitted you will be directed to a page to pay your $50.00 fee. You will receive a confirmation email after submitting this form. If you do not receive the confirmation email, check your spam/junk folder. If you have problems submitting this form, please call 317.289.3242.

NOTE: Enter the library through the east entrance, not the main entrance. 450 S Jefferson Street, Brownsburg, Indiana 46112. The panel will be in the Pearson Room.

Read the guidelines to attend in person

Request the date you would like to attend Survivor Speakout IN PERSON at the Brownsburg Public Library. All panels are from 9:45 A.M. to 12:00 P.M.

THE LIBRARY PRESENTATION IS IN ENGLISH ONLY.

Date *Choose a date to attend IN PERSONSaturday, August 16, 2025Saturday, September 27, 2025Saturday, October 18, 2025Saturday, November 15, 2025

First Name /Last Name *

First

Last

Address *

Address Line 1

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

over QUESTIONS 12:00

Email *

Email

Confirm Email

Telephone *

On what charges were you arrested?

Charge *Choose oneDWIDUIOWIOUIPIMinor in ConsumptionOpen ContainerIllegal possession of alcoholDrug RelatedOther

Your probation officer

Probation officer *Choose oneAbigail O’BrienAlex RedmanAndrew LillpopAshley StarlingBetsy SchulerBen NeureiterBrandon FowlerBrittany StodghillCaleb LazanoCaleb NanzerCarmen SimsCarol NienaberCheryl KochChad KoebckeChad UlmerChantel CloudChristina CandiaCorey WalkerCourtney SacchiniDwight StevensonElizabeth KriegErinn McCluneyFaith EdwardsFaith OliverJamie WodtkeJana SchwindtJesse TuckerJohni TaylorJustin CulpKatrina SkeltonKevin McCleeseKristin UshmanLeah BakerMalachi TaylorMariah MyersMcKinzee TerryMegan CarusoMegan MorgusonMelody SearsPatrick GillianRebecca ShrockReid RoetheRichard PorterRichard MartinezRonda GibsonShelby WiserStephen OwensSteve RobertsSuzan Shrock-GideonThomas PurkhiserTim MillerZach MinardoMy probation officer is not listedI do not know my probation officer's nameI have a plea/diversion agreement

Who is the judge presiding over your case?

Judge *Choose oneThe Honorable Rhett StuardThe Honorable Dan ZielinskiThe Honorable Mark SmithThe Honorable Stephanie Lemay-LukenThe Honorable Charles E. HostetterThe Honorable David ColemanThe Honorable Travis CraneThe Honorable Lindsay R. WalkerThe Honorable James D. SpencerThe Honorable Maureen T. OwenThe Honorable Bruce E. PetitThe Honorable J. Jeffrey EdensThe Honorable Matt HeadleyThe Honorable Tammy SomersThe Honorable Clayton A. GrahamThe Honorable Amy JonesThe Honorable Ryan TanselThe judge presiding over my case is not listedI do not know my judge's name

If you know the name of your judge but they are not on the list, enter it here

Your age *Choose one15-1819-2526-3031-3536-4041-4546-5051-5556-6061-6566-7071-7576-8081-8586-9091-9596-100

County information

In which county were you arrested, charged or convicted? *Choose oneAdamsAllenBentonBlackfordBooneBrownCarrollCassClarkClayClintonCrawfordDaviessDearbornDecaturDeKalbDelawareDuboisElkhartFayetteFloydFountainFranklinFultonGibsonGrantGreeneHamiltonHancockHarrisonHendricksHenryHowardHuntingtonJacksonJasperJayJeffersonJenningsJohnsonKnoxKosciuskoLaGrangeLakeLaPorteLawrenceMadisonMarionMarshallMartinMiamiMonroeMontgomeryMorganNewtonNobleOhioOrangeOwenParkePerryPikePorterPoseyPulaskiPutnamRandolphRipleyRushSt. JosephScottShelbySpencerStarkeSteubenSullivanSwitzerlandTippecanoeTiptonUnionVanderburghVermillionVigoWabashWarrenWarrickWashingtonWayneWellsWhiteWhitleyI do not live in Indiana.

If outside of Indiana, list the city and state where you were arrested, charged or convicted

In which county do you live? *Choose oneAdamsAllenBentonBlackfordBooneBrownCarrollCassClarkClayClintonCrawfordDaviessDearbornDecaturDeKalbDelawareDuboisElkhartFayetteFloydFountainFranklinFultonGibsonGrantGreeneHamiltonHancockHarrisonHendricksHenryHowardHuntingtonJacksonJasperJayJeffersonJenningsJohnsonKnoxKosciuskoLaGrangeLakeLaPorteLawrenceMadisonMarionMarshallMartinMiamiMonroeMontgomeryMorganNewtonNobleOhioOrangeOwenParkePerryPikePorterPoseyPulaskiPutnamRandolphRipleyRushSt. JosephScottShelbySpencerStarkeSteubenSullivanSwitzerlandTippecanoeTiptonUnionVanderburghVermillionVigoWabashWarrenWarrickWashingtonWayneWellsWhiteWhitleyOther

If outside of Indiana, list the county and state where you live

How did you hear about Survivor Speakout?

• My probation officer
• My attorney
• Online search
• Other

If you chose "Other" above, tell us how you heard about Survivor Speakout?

GUIDELINES *

• I have read and understand the Survivor Speakout Guidelines to attend IN PERSON

This is a graphic presentation *

• I understand that the Survivor Speakout Victim Impact Panel is graphic in nature dealing with death

COMMENTS / QUESTIONS

What number comes after 6?

Submit

Please, do not contact the library about attending the Survivor Speakout Victim Impact Panel. The Brownsburg Public Library is not sponsoring or endorsing the subject matter of this meeting. Contact Survivor Speakout directly with questions. 317.289.3242