Registration 2009 Chosen First Name * Chosen Last Name * Preferred Pronouns Do you have any accessibility needs? (** Language?) No. Yes, ASL interpreter required. Yes, large print packet required. Yes, braille packet required. Yes, wheelchair accessible parking required. Yes, other listed below. Please note: The Davis Centre is both wheelchair and elevator accessible. Scent free single stall, gender neutral, and segregated bathrooms are all availible. Other accessibility needs How did you hear about TIC? -Select-Word of mouthPosterEmailWebsiteT-Shirt or other TIC MerchandiseOther How else did you hear about us? Email Address Would you like to be added to our email listserve? * -Select-YesNo Are you a college or organization affiliate? Yes, student. Yes, staff. Yes, faculty. No. If so, which college or organization are you affiliated with? If you are a queer person of color, would you care to attend a closed lunch hosted by QPOC (UVM's group for queer people of color)? Yes No Any other comments? Disclaimer: The following questions are optional information for statistical purposes only. No identifying information will be connected to this data. What city/state or country do you currently reside in? What city/state or country did you grow up in? NOTE: After hitting "Submit," your form should return to being blank. This means that it has indeed submitted to our database. It is also unneccessary to hit the button twice, this will only submit your information twice into our database. If you have any problems, please email Trist at mpulley@uvm.edu. Thanks! Verification Code (enter the characters you see in the above picture) View Error Details Powered by
