MTPC Projects: Transgender Youth Summit Registration Form

Preferred or Chosen Name:

Age:

Gender Identity:

Preferred Pronoun:

She He Both Neither Other
If other:

City:

Zip Code:

Email:

Phone Number:

If you do not answer, should we leave a message stating who we are and why we are calling?
Yes No

School name, if any:

Grade/level:
If you attend a GLBT youth group outside of school, name of group:

Vegetarian?

Yes No

Food Allergies:

Do you need a transportation stipend?^* Yes No
If yes, how much (estimate is fine):

Commuter Rail:

Subway:

Bus:

*Transportation stipends will be distributed the day of the event. A receipt will be required for reimbursement. If you need the stipend before then, please call 617-778-0519 to make arrangements.

Did you attend last year's Trans Youth Summit? Yes No

How did you hear about the Transgender Youth Summit? (check all that apply)

MTPC website
MTPC email
BAGLY
Facebook
Flyer
Youth Pride

Other GLBT youth group
Other Pride event
Other Email
Friend
Other

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