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Youth Track
Register
Schedule
Workshops
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Schedule
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Get Involved
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Youth Track – Register
Ari Desano
2020-08-31T15:54:19-07:00
Youth Track Registration Form Here
Youth Registration 2020
Please enter a Username to create an account. If you already have an account
please login
before completing this form.
Username
*
Check Availability
Punctuation is not allowed in a Username with the exception of periods, hyphens and underscores.
Password
Confirm Password
Provide a password for the new account in both fields.
Youth Registration 2020
First Name
*
Middle Name
Last Name
*
Email Address
*
Cell Phone (use 123-456-7890 format)
Ok to text?
Yes
No
Birth Date
*
Current City of Residence
*
Current Zip Code
*
Personal Gender Pronouns (she/her/he/him/they/zir)
*
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
What are these?
If other gender identity, please specify in box below:
Sexual Orientation
Pansexual
Queer
Bisexual
Lesbian
Gay
Straight
Other
What are these?
If other sexual orientation, please specify in box below:
How did you hear about Models of Pride 28?
*
Previously Participated
Family
Friends
My local LGBT Center
Centerlink or Youthlink
My school
Facebook
Instagram
Other
If other, from whom/where?
Are you in school?
Yes
No
If yes, what level?
What made you interested in attending this conference? (select all that apply)
A need to connect with other LGBTQ Youth
I’m looking for resources and support that support my identity
I’m interested in participating in the workshops
Education on topics affecting LGBTQ Youth
I love everything Queer!
We will be hosting various chat rooms throughout the conference and would love your input on what types of chat rooms you’d be interested in joining! Please tell us your interests here:
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:
Models of Pride 28 Release and Waiver of Liability
Participating in the Models of Pride conference requires agreeing to our Release and Waiver of Liability
*
I agree to the Release and Waiver of Liability.
Release and Waiver of Liability
.
Connect
modelsofpride@lalgbtcenter.org
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