Community Care Liaison (CCL) Application
Name
*
First Name
Last Name
Age
*
Email
*
example@example.com
City, State of Residence
*
Pronouns
*
What is your gender identity?
*
How often do you attend nightlife spaces? (i.e. clubs, bars, lounges etc.)
*
Please Select
Not at all
On occasion (1-2 times a month)
Often (3-4 times a month)
Somewhat often (5-6 times a month)
Very Often (Weekly/ 6+ times a month)
How do you feel about substance use in nightlife environments?
*
What cities do you party in most frequently?
*
What does 'Consent' mean to you?
*
What does 'Harm Reduction' mean to you?
*
What does 'Safety' mean to you?
*
Describe your relationship with Transgender/Non-Binary people.
*
Do you have any experience with AV/Sound Production equipment?
*
Yes
No
Submit
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