Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Organization/Business/Affiliation Type

Please check all that apply.

LGBTQIA+ LED NON-PROFIT

LGBTQIA+ ARTIST

LGBTQIA+ OWNED SMALL BUSINESS

NON-PROFIT/ORGANIZATION/BUSINESS WHOSE MAIN DEMOGRAPHIC IS LGBTQIA+ INDIVIUDALS

SMALL NON-PROFIT ORGANIZATION (operating budget under $1.5 Million)

LARGE NON-PROFIT OR NGO (operating budget over $1.5 Million)

SMALL BUSINESS

LARGE BUSINESS

HEALTHCARE PROVIDER

HEALTHCARE PROVIDER SPECIALIZING IN TRANS/GEDNER EXPANSIVE CARE

RELIGIOUS/FAITH BASED INSTIUTION

FOOD VENDOR

BEVERAGE VENDOR

Please acknowledge below that you understand that submission of a tabling partner application does not confirm or guarantee acceptance as a tabling partner. I also understand that if accepted, my registration is not complete until my payment is made in full, if applicable. *

I understand and agree