Name *

First Name

Last Name

Phone *

(###)

###

####

Your Business/Organization is: *

LGBTQ Owned

LGBTQ Ally

Does your Business/Organization have a Non Discrimination Policy that includes LGBTQ+? *

Yes

No

If No, would you be willing to add one to your policies?

Yes

Yes, but need help

No

Does your Business/Organization operate in the Michiana area? *

Yes

No