PFLAG Connects Sign-up Sheet

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PFLAG Connects Sign-up Sheet - Formulario

Please fill out these questions to the best of your ability. This information is gathered for intake purposes only and will not be shared with anyone. Once you submit this form, we will send you an email the morning of the meeting with instructions on how to join the meeting.

Por favor responda estas preguntas lo mejor que pueda. Esta información es para uso interno y no sera compartida con nadie. Una vez que envie este formulario, le enviaremos un email la mañana del dia de la reunión con instrucciones para conectarse.

Email *

First Name, Last Initial - Nombre, Inicial del Apellido *

Personal Pronouns - Pronombres Personales

How did you find out about this virtual support group? - Cómo se entero de este grupo de ayuda virtual?

Email List / Lista de Email

PFLAG Omaha Website / Website de PFLAG Omaha

PFLAG National Website / Website de PFLAG National

Social Media / Medios Sociales

Family or Friend / Familia o Amigxs

Other:

Clear selection

Is there anything specific you would like to talk about or have the facilitator bring up during the meeting? - Algún tema en especial que le gustaría hablar o quien dirige la reunion lo haga

Are you under the age of 18? - Es mayor de 18?

Yes / Si

No / No

Clear selection

Submit

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