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Youth AFFIRM
Please answer the following questions so we can register you for the training and be sure to accommodate any childcare and dietary requests.
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Please enter your first and last name here *
Please enter your address with zip code here *
Please enter your birthdate (MM/DD/YYYY) *
What is the best method to contact you about AFFIRM? Please share as much information as possible to help us coordinate communication with you. For example: Contact me at (xxx)xxx-xxxx by texting after 3p and before 9p. *
Are you involved with any of the following systems? *
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What pronouns do you use? *
What is your sex assigned at birth? *
What is your gender identity? *
What is your sexual orientation? *
What is your race? (Choose one or more) *
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What is your ethnicity? *
How did you get referred to AFFIRM
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