LBT+ Women and Non-Binary Person's Peer Support Group registration form

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1. What is your name? *

 

2. What age group are you in? *

 

3. What is your home address? *

 

4. Which local authority area do you live in? *

 

5. How do you describe your gender identity? *

 

6. Is your gender different to that which was assigned to you at birth? *

 

7. What are your pronouns?

 

8. How would you describe your sexual orientation? *

 

9. How would you describe your ethnicity? *

 

10. Do you have any religion or belief? *

 

11. Do you have any disabilities and/or describe yourself as disabled? *