LGBT & Ally Training - Iowa Pride Network

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lgbt & ally training

Name:	(required)	E-mail:	(required)
Address:		State:
City:		Zip:
Cell Phone:		Home Phone:
Age:		School (if applicable):
Grad Year:		Organization (if applicable):
Event:

Iowa Pride Network strives for diversity in all aspects of its programs. The following three questions are optional but are very important to us:

Gender(s):
Sexual Orientation(s):
Ethnic Background(s):

NOTE: if you are under 18, please fill out the “Parent/Guardian” and “Medical Release” Forms available at http://www.iowapridenetwork.org/training. If you are over 18, please provide the necessary emergency contact information in the medical release.

PHOTO RELEASE (optional):
Please be advised that I hereby authorize Iowa Pride Network to reproduce my image, photographed or filmed for publicity and fundraising purposes.

By selecting "yes" in this box, you agree to the photo release

Iowa Pride Network
777 Third Street, Suite 312
Des Moines, Iowa 50309
Executive Director: 515-471-8062
Outreach Coordinator: 515-471-8063