PO Box 1074, Pomona, CA 91769

Please fill out the following form/survey to be added to our mailing list. If you are interested in volunteer opportunities, would like to donate to the center or would like to be contacted, please fill in the appropriate information. Thank you for your interest in the Pomona Pride Center!

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* 1. What is your name?

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* 2. What is your email address?

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* 3. What is your contact phone number?

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* 4. What is your zip code?

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* 5. What is your date of birth?

Date

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* 6. How do you identify?

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* 7. What is your race or ethnicity?

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* 8. What area's are you interested in?

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* 9. Is there anything else you would like to add or suggest to the center? What services would you like the Pomona Pride Center provide? Please be detailed.

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