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Queens Clinic Escort Interest Survey
Thank you for your interest! Please fill out this form and we will be back in touch with you by email to let you know of training and volunteer opportunities for clinic escorting.
For any questions, please email
queensclinicescort@gmail.com
.
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Email
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Your email
First & Last Name:
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Your answer
Pronouns
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Your answer
Phone:
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Your answer
Why do you want to become a clinic escort?
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Your answer
What are your beliefs about abortion?
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Your answer
What, if any, background do you have in reproductive rights?
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Your answer
Do you speak any languages other than English? If so, what?
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Your answer
Please provide two references including their name and contact info (phone and/or email).
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Your answer
Where did you hear about this opportunity? If you heard about us from a current or former escort, please include their info here.
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Your answer
Follow this link to sign up for a virtual training date:
https://signup.com/go/OaGxXhM
*
I signed up!
I need a future date/alternate date
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