LGBT & Ally Training - Iowa Pride Network

LGBT & Ally Training

Registration Form

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