Stay Up Registration Form

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Stay UP serves as social support group for queer, Black men who are living with HIV. This series will consist of a weekly vogue class taught by Packrat of Legendary season 1. Each session will consistent of an opening check-in followed by a vogue lesson. Vogue class kits will be mailed out to participants to make the classes comfortable with the appropriate gear.

The program begins May 6th, 2021.

Contact us at joshuaR@blackaids.org or richardD@blackaids.org for questions or more information.

First and last name *

Gender *

Cisgender Male

Transgender Male

Cisgender Female

Transgender Female

Non Binary

Gender Nonconforming

Gender Fluid

Agender

Bigender

Two-Spirit

None

Not sure

Decline to answer

Pronouns *

They/Them

He/Him/His

She/Her/Hers

Xe/Xir/Xirs

Other:

How would you like to receive your vogue kit? *

I would like it mailed to my mailing address

I would like to pick it up at the BAI office

I would like it dropped off by staff at my mailing address

Mailing address *

Email address *

Phone number

Birth date

YYYY

T-shirt size *

XXL

Instagram

Are you in need of immediate assistance for meeting an essential need (i.e. rent, groceries, housing, professional training)? *

Are you currently linked to HIV services? If not, would you like us to link you these services? *

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