JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Nominate an LGBTQ+ Changemaker
Do you know someone who is making a big difference in their local LGBTQ+ community or beyond? Let us know and we may feature them in a future Changemaker article.
Sign in to Google
to save your progress.
Learn more
Your name
Your answer
Your email address
Your answer
Who are you nominating as an LGBTQ+ Changemaker?
Your answer
Why are they a Changemaker?
Your answer
What's the best way to contact your Changemaker?
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Local Media Association.
Report Abuse
Forms
