Gateway to Liberation: Your Body, Your Life, Your Rights-Youth Summit
Saturday, July 7, 2018 from 8:30 AM-4:45 PM. Planned Parenthood 2430 Poplar Ave. Memphis, TN 38112
Please answer the following questions to the best of your ability.
* Required
Name (First and Last)
*
Your answer
E-mail Address
*
Your answer
Phone Number
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Your answer
Age
*
Your answer
Please indicate your racial background and/or ethnicity. Check all that apply.
Black/African American
Asian American/AAPI
Indigenous/Native American
Latinx
Middle Eastern
Multi-racial
White
I do not wish to answer
Gender Identity (Please check all that apply)
Woman
Man
Gender Non-Conforming
Cisgender
Transgender
Intersex
I do not wish to answer
Are you a student?
Yes
No
What is your school affiliation?
Your answer
T-shirt size (based on unisex sizing)
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L
XL
XXL
XXXL
We will be providing breakfast and lunch. Do you have any dietary restrictions? Please check all that apply.
*
Vegetarian
Vegan
No pork
No beef
Gluten-free
No nuts
Dairy free
No dietary restrictions
Other:
Required
Are you interested in volunteering?
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No
What are you hoping to gain from this summit?
Your answer
Questions/Comments
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