Clone of New Customer Registration Form

Are you part of the LGBTQ+ Community?

YesNoAllyPrefer not to say
Would you attend a social group that is a safe supportive space for LGBTQ+ and allies?

YesNo
Would you prefer :

Face to faceOnlineNo preference
What barriers might prevent you from participating?

TravelTimeSocial AnxietyCommunicationSensory Needs
Other :
What would you like to gain from participating :

Sense of belongingConfidence buildingBuilding friendshipsA safe non-judgemental space
Other :
What day suits :*

TuesdayWednesdayThursday
Time :*

MorningAfternoonEvening
If you would like an update on the information shared in this survey please provide an email address :
example@example.com
We would love to invite you or anyone interested to drop in to our coffee, cake and tea evening to share your ideas on an LGBTQ+ group on January 27th, 4:30pm - 6pm at The Place 56 Newmarket Street, Ayr.
Should be Empty: