LGBTQIA+ Caucus of New Mexico Registration Form

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Register or Renew your interest in the LGBTQIA+ Caucus of DPNM. Edit your responses at any time, and/or email reach out to the secretary to request any updates.

Email *

First & Last Name(s) *

What name(s) would you prefer to use? (This can be changed at any time by contacting the Caucus Secretary.)

Pronoun(s)

Check as many boxes as you would like, and/or type your own. Split pronouns are welcome.

they/them

she/her

he/him

Other:

Phone Number *

(Please include area code.)

Is it okay if someone from the caucus reaches out to contact you? *

Yes, Phone

Yes, Email

Yes, Text

Required

Are you a registered democrat? *

Yes

No, I need to go to NMVOTE.org

County *

Are you interested in a leadership role within the caucus? *

Yes

Maybe

Other:

Do you identify as a member of the LGBTQIA+ community? *

Yes

Ally

Maybe/Questioning/Unsure

Other:

Required

(OPTIONAL) Do you identify as a sexual minority?

(such as: gay, lesbian, bisexual, pansexual, asexual/ace-spectrum, etc.)

Yes

Maybe

Other:

Clear selection

(OPTIONAL) Do you identify as a gender minority?

(such as: transgender/non-binary/genderqueer/non-conforming/intersex/etc.)

Yes

Maybe

Other:

Clear selection

Note(s)

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms