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Your Information
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1.
Contact Information
(Required.)
Full Name
*
Your preferred email address
*
Your preferred phone Number
*
2.
Are you a Together Member
(Required.)
Yes
No
3.
Member ID (If known)
4.
Employer Name
5.
Workplace
6.
Are you a member of the LGBTIQ+ and/or gender diverse communities?
Yes
No
7.
If you feel comfortable, do you identify as
Lesbian
Gay
Bisexual
Trans
Intersex
Queer
Other (please specify)
8.
What are your pronouns? Select any/all that you use
She/her
He/him
They/them
Other
9.
What is your title/prefix?
Miss
Ms
Mrs
Mr
Mx
10.
Are you a union activist or delegate interested in being in the Together Pride Network?
Yes
No
No, but I am interested in staying in the loop
No, but I am interested in becoming a delegate or activist in my workplace
11.
Are you involved in a Pride Committee in your workplace? If so, what is the name of the committee?
No
Yes, please write the name of the committee in the comment field if applicable.
12.
Have you experienced or witnessed discrimination against LGBTQ+ and gender diverse workers in your workplace?
Yes, all the time
Yes, some of the time
Yes, rarely
No, not at all
If you clicked one of the
Yes
options, and are comfortable to, please share an example below.
13.
What LGBTIQ+ issues are important to you?
Lack of visibility
Stopping discrimination, harassment/bullying, homophobia and transphobia in the workplace
Creating network and support for LGBTIQ+
Positive organisation workplace policies
Complaints processes against discrimination
Other (please specify)
14.
If you have success stories or examples of good practices or policies in community or in your workplace, please share an example below.