Testimonial form (! I'm the only one able to read!)

Hello, and congratulations for the bravery that has brought you so far. Whether we've already talked via Instagram or any social network, or you've just discovered the hashtag #UberCestOver: it doesn't matter.
Here you can feel safe to testify. I am particularly addressing people who have never spoken of their assault nor to their friends nor their parents: they never will be informed that you filled this form/
The flood of testimonies (on my Instagram page in particular) overwhelmed me. This website : ubercestover.org, and this form aim to help me collect.
You can be absolutely sure that your voice will be carried - and that I will be the only one to know your identity.
Wonderful morning / day / evening - thank you very much for your confidence (for yourself, for others victims).
I send you much love. You're not alone anymore.
When did the incident that you want to relate happen?
In which city did the incident that you want to relate take place? (city name, no postal code please)
Your answer
Where do you currently live? (city name, no postal code please)
Your answer
How old were you when the event took place? (in numbers)
Your answer
How would you classify what happened to you? (inappropriate behavior = remark or attitude that created diffuse discomfort; harassment = sexual remarks, refusal to open the doors, obligation to give the phone number or any personal information; sexual assault = unwanted touch, kiss or caress, rape = unwanted penetration (digital, oral, vaginal, anal))
Have you complained? (to the police)
If help is provided, are you considering legal action?
Can you briefly tell me what happened? (If you have already done so on social networks, don't hesitate to leave me your @, so I can directly find your testimony.)
Your answer
Have you reported the case to Uber?
For those who reported, has your ride been deleted from your history?
Do you remember the name of your driver?
Your answer
What is your name ? (again, EVERYTHING stays between us.)
Your answer
Check this box if you could potentially testify in the media (anonymously)
Bravo, you're at the end! Do you have something special to add?
Your answer
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