Out List / Allies List sign-up form
Name
First Name
Last Name
Title
Department
Office Number
Phone Number
-
Area Code
Phone Number
Email
example@example.com
By checking the box below:
Please check ONE of the boxes below:
I WANT TO BE ON THE OUT LIST*
I WANT TO BE ON THE ALLIES LIST**
I am interested in: (check all that apply)
being a member of LMC’s LGBTQ Task Force
Safe Space / Allies training
mentoring LGBTQ students
Your signature
Submit
Should be Empty: