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B3 New Member Form
Please fill out the form below to join our B3 community!
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
What is your phone number?
Your answer
What are your pronouns?
He/him
She/her
They/them
Other:
What is your gender identity?
*
Female
Trans female
Male
Trans male
Non-binary
Genderqueer
Prefer not to disclose
Other:
Required
What is your ZIP Code?
Your answer
How would you best describe yourself?
*
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Are you of Hispanic/Latino/Spanish origin?
*
Yes
No
When is your birthday?
*
MM
/
DD
/
YYYY
How old are you?
*
Your answer
What is your preferred email address to receive B3 updates and Zoom links?
*
Your answer
Do you identify as an ally to the disability community or as a person with a disability?
*
Ally
Person with a disability
I prefer not to disclose
If you are currently in high school or college, where do you go to school? If you are out of school, leave this question blank.
Your answer
What are your interests and/or hobbies (things you like to do)?
Your answer
Why do you want to become a B3 member? (you can check more than one)
*
Volunteer at coffee pop-ups
The social opportunities, making friends
Get involved in my community
Get a paid internship
Build confidence
Participate in B3 programs
The coffee!!
Grow as an ally
Grow as a self-advocate
Required
B3 has community standards to maintain a safe and respectful community for all. Please read each standard carefully and check "Yes" if you agree to follow it.
Being: Understand that the way we express ourselves is different between each member and we should celebrate those differences. Respect everyone’s personal decisions and boundaries in recognition that each B3 member will do what is best for them. *If you are concerned about someone's health or safety, please contact a B3 staff person.
*
Yes
No
Belonging: Everyone belongs. B3 members should welcome and be inclusive of all long-time and new members. B3 members will support their peers, regardless of differing beliefs, preferences, abilities, cultures, identities, or opinions.
*
Yes
No
Becoming: B3 members will work towards building a strong, inclusive community within B3 Coffee and community partners. B3 members will recognize and embrace the importance of diversity in becoming better together.
*
Yes
No
All B3 members are required to watch our Community Standards training video, which can be found here:
https://youtu.be/P8Huz63zPnU
There are also several tip sheets to review, which are linked in the caption of the Youtube Video.
*
Yes
No
COVID-19 Policy: B3 Follows the masking/COVID policies of the venues we operate within (i.e., The Chapel Hill Public Library, The Holy Trinity Lutheran Church). Currently, masks are optional at all venues. Please do not come to a B3 event if symptoms of COVID-19 are experienced.
*
I understand and agree
Required
Please keep in mind that B3 cannot provide personal care (i.e., feeding, toileting, medication administration) or one-on-one behavioral support. Please invite a caregiver or loved one to join you if you require these types of support.
*
I understand and agree
Required
In attending B3 events I acknowledge that B3 may capture photos or videos that I will be pictured in. I consent to B3 using these photos/videos, without my name, to share about the event on social media and the B3 website.
*
I understand and agree
Required
How did you hear about B3?
*
Seeing B3 at the Chapel Hill Public Library
B3's social media
Other social media
A friend
A family member
B3's website
Another organization
A B3 pop up
Other:
Required
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