Name *

First Name

Last Name

I agree to be added to the IJC mailing list *

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Do you identify as (please check all that apply)?

American Indian, Alaska Native, or Indigenous

Asian or Asian American

Black or African American

Hispanic, Latino/a/x, or Latin American

Middle Eastern

Multiracial or Multi-ethnic

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White

Race or ethnicity not included above

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Do you identify as a person of color?

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No

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Select the age range that applies to the year of your birth

1920-1929

1930-1939

1940-1949

1950-1959

1960-1969

1970-1979

1980-1989

1990-1999

2000-2009

2010-2019

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Do you identify as an individual with a disability?

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No

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Are you a military veteran, on active duty, in the reserves, or a military spouse?

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No

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Do you identify as a (please check all that apply)?

Woman

Man

Two-Spirit

Gender Non-Conforming

Agender

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Do you identify as (please check all that apply)?

Asexual

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Pansexual

Queer

Other Identity

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