Contact Form for New York Support Group
WHAT: This group is a private gathering for people who identify as LGBTQ and are Orthodox, Ortho-curious, or formerly Orthodox. The group is confidential and anyone who attends agrees to keep confidentiality.

WHEN and WHERE: Meetings times and place are announced on our website and through our mailing list. Check out our website for times. Visit our website at www.eshelonline.org


All information on this form will be kept confidential.

Email address *
First Name: *
Last name *
Zip Code you live in *
City you live in *
Please tell us a bit about yourself
How do you identify:
Would you say you have support for what you are going through?
What do you hope to get out of this group?
Can we add you to the mailing list? If so, please provide your address, phone and contact info:
How can we contact you? *
Name you would like to be called/Pseudonym
Would you like to help organize this group and other Eshel activities in the area? *
A copy of your responses will be emailed to the address you provided.
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