Member Registration

Member Registration Form

* Indicates required field

First Name *

Last Name *

Address *

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City

State

Zip Code

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Email *

Phone Number *

Please indicate your gender: *

Woman/Girl Man/Boy Transgender Genderqueer Genderfluid Gender Nonconforming Nonbinary Two Spirit Bigender Agender Intersex Prefer Not to Say Other

If Other, please specify: *

Please indicate your gender pronouns. *

She/Her/Hers He/Him/His They/Them/Theirs Ze/Hir/Hirs No Pronoun, Use Name Prefer Not to Say Other

If Other, please specify: *

Please Indicate your sexual orientation. *

Bisexual Pansexual Queer Fluid Unlabeled Biromantic Asexual Gay Lesbian Straight/Heterosexual Prefer Not to Say Other

If Other, please specify: *

Please select your racial/ethnic identity: *

African American/Black Latino Asian/Pacific Islander Native American/Indigenous Caucasian/White Prefer Not to Say Other

If Other, please specify: *

What are one or more things you are hoping to accomplish with your membership? *

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