Resource Application Form

Resource Application Form
Contact Name*

First NameLast Name
Business Name*
Date Business Started

MonthDayYear
Date
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Business Type:

Beauty/Self-CareCrisis/ShelterNon-Profit - Food/SuppliesNon-Profit - ResourceRestaurantRetail - GeneralRetail - ApparelRetail - GroceryRetail - Specialty (Please specify in additional information)Safe EmploymentSafe SpaceOther
Please indicate additional items you are interested in:

Access to exclusive eventsNetworking opportunitiesProfessional development resourcesSubscription to newsletters or publicationsVolunteer opportunitiesSponsorship opportunities (including advertisement)
Are you LGBTQIA+ owned or operated?
Additional Information:
How did you hear about us?
Why are you interested in being listed as an LGBTQIA+ friendly resource?*
Please provide a description of your business/service.*
Do you have public restrooms? If yes, please describe (are there individual stalls, is there a family restroom, how are they labeled, do employees have the right to question who walks into the restroom). If no, mark NA*
What policies/safeguards are in place to protect marginalized communities in your business? What is your complaint policy if an employee does not act appropriately?
Any other comments?
Declaration:

I certify that all information provided in this application is true and accurate to the best of my knowledge. I understand that membership approval is at the discretion of the Board of Southern Idaho Pride and may be subject to review.
Signature*

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Date

MonthDayYear
Date
Should be Empty:

Resource Application Form

Additional Information: