SHARE YOUR STORY- We are looking to connect with folks who have taken the survey and are willing to share their personal story about what it's like to be LGBTQ in the South.

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* 1. Name

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* 2. Email

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* 3. Phone Number

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* 4. What's the best way to reach you?

Email

Phone

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* 5. If we reach out to you, do we need to be discreet?

Yes

No

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* 6. What state do you live in?

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* 7. Tell us your story.

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* 8. Do you feel your personal story speaks to...(select all that apply)

Criminal Justice

Education

Employment

Public Health

Safety

Other (please specify)

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* 9. As we release the results from the Southern Survey, we may have media and other researchers who are interested in hearing the personal stories of LGBTQ people in the South. May we reach out to you and potentially connect you with interested media/researchers?

Yes

No