Great Trans American Road Trip

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Name* This field is required.
First Name
Last Name
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Pronouns* This field is required.(e.g., she/her, they/them, he/him)
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Email* This field is required.Will only be used for direct contact. Will not be used or sold to any third party or in any mass communication.
example@example.com
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Phone NumberWill only be used for direct contact. Will not be used or sold to any third party or in any mass communication.
Please enter a valid phone number.
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Social Media Handles* This field is required.Used to verify the authenticity of your location and identity.
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Country* This field is required.Let us know where you live!
USA
Canada
Mexico
Other
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State (if within USA)
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Region within United StatesScroll down to find your region or select other.
Please Select
Please Select
Pacific Northwest
West Coast
Southwest
Midwest
South
Southeast
East Coast
Great Lakes
Alaska
Hawaii
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City or County* This field is required.
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I am hoping to ...* This field is required.Select all that apply. Please note that to be considered for an interview you must currently reside in the United States, Canada, or Mexico, identify as transgender or nonbinary, and agree to a recorded interview that will be made available online.
be interviewed as part of the Great Trans American Road Trip
host Chapel Roamin' (Flint & Xilo's trailer) at my home, property, or business
support Flint and Xilo with goods or services
Other
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Do you consider yourself trans and/or nonbinary?If your answer to this question is “no,” I will not be available to interview you for this project.
YESNO
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Do you currently reside in the United States, Canada, or Mexico?If your answer to this question is “no,” I will not be available to interview you for this project.
YESNO
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Tell me a little about yourself and your experience as a trans and/or nonbinary person in your region:
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Why would you like to be involved in the Great Trans American Road Trip?
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What concerns do you have about your involvement, if any? What would be helpful in addressing those concerns?
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Gender
Man
Woman
Non-binary
Gender Queer
Other
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Sexual Identity
Gay
Lesbian
Bisexual/Pansexual
Straight
Asexual
Queer
Other
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Racial/Ethnic Identity
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What kind of space do you have available?
Residential property with a large parking area/RV Pad
Large rural property (e.g., farm)
Commercial space (e.g., parking lot)
Campground/RV Park
Other
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Which of the following does your space have access to?Select all that apply.
At least 28 feet of relatively level ground for parking
City or Well Water Spigot (within 25 feet)
City or Well Water Spigot (within 200 feet)
20 amp electric within 25 feet (most common household electrical outlet)
30 amp electric within 25 feet
50 amp electric within 25 feet
Sewer hookup within 25 feet
Relative privacy from surrounding residences and business
Not sure
None of these
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Have you hosted a travel trailer or RV in this space before?
YESNO
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How long can the space be made available for?
Overnight
2-5 days
6-10 days
11-20 days
21-30 days
30+ Days
Other
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What sort of compensation would you be seeking for use of the space?
None
Reimbursement for electric/water usage
A rental fee beyond the cost of electric/water
A rent for trade (e.g., workshop, speaking event, art piece, coaching, or counseling)
Not Sure
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What else can you tell us about the space?
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What else should we know about you and your community?
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What sort of help are you able to offer Flint and Xilo if they come through your community?
Monetary Contribution
A meal
Expertise in Solar Installation
Truck Maintenance
Airstream Maintenance
Access to a private hot tub
Professional massage/acupuncture/chiropractic service
Other
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Please explain what it is you would like to offer and how you would like to help:
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What else would you like us to know?
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