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Models of Pride 30 – Youth Registration 2022
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2022-06-21T11:53:46-07:00
Youth Registration
First Name
*
Last Name must match that of your COVID-19 Vaccination Card or Negative PCR Test
Last Name
*
Email Address
*
Cell Phone
Birth Date
*
Current City of Residence
*
Current Zip Code
*
Personal Gender Pronouns (she/her/he/him/they/zir/any)
*
Race
*
Black/African American
Latinx / Hispanic
Asian Pacific Islander
Caucasian (Non-Hispanic)
Native American
Multi Racial
Other
If other race, please specify in box below:
Gender Identity
*
Cisgender Woman
Cisgender Man
Transgender Man
Transgender Woman
Gender Queer
Nonbinary
Other
Other gender identity:
Sexual Orientation
*
Pansexual
Queer
Bisexual
Lesbian
Gay
Straight
Other
If other sexual orientation, please specify in box below:
Choose up to three categories of workshops you would like to see at Models of Pride
*
Activism / Social Justice / Self-Empowerment
Arts & Culture / Education
Coming Out / Families / Spirituality / Faith
Education / Careers
Gender / Sexuality / Health
People of Color Community & Issues / Ally Community & Issues
Other (enter in box below)
If you would like a workshop category that is not listed, please specify in box below
How did you hear about Models of Pride? (select all that apply)
*
Previously Participated
Family
Friends
My local LGBT Center
Centerlink or Youthlink
My school
Facebook
Instagram
Other
If other, from whom/where?
We will do our best to provide assistance.
Do you need any of the following accommodations?
ASL interpreting (provide specifics in area below)
Alternative language translation (provide language in area below)
Accommodations details:
T-Shirt Size
XS
S
M
L
XL
2XL
I don't want a T-Shirt
Dietary Restrictions
Vegan
Gluten-Free
Emergency Contact Name
*
Emergency Contact Phone Number
*
COVID-19 Proof of Vaccination
*
I will bring proof of my COVID-19 vaccination or a negative test.
By clicking "Yes" I agree to the Models of Pride Release of Liability.
Models of Pride Release of Liability
*
Yes
Release and Waiver of Liability
.
Register
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