University of Rochester
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Pride Alliance


Membership Eligibility

Membership is open to ALL staff, faculty and retirees of the University of Rochester who support the mission of the Pride Alliance of the University of Rochester.

Contact Information
First Name:
Last Name:
Email:
UR Extension:
Preferred Phone:
Department/Division:
   
The following information is used for statistics only:
Gender:
Ethnicity:
Date of Birth:
   
E-mail Preferences
I wish to receive e-mails about:
Pride Alliance Meetings and Updates only
Other events that may be of interest to Pride Alliance members
   
Privacy Preferences
Please include my contact information on a contact list for Pride Alliance members.
Yes No
 
Please include the following information on a contact list for nonmembers: (Leave blank if you do not want your information to be shared externally.)
First Name
Email Address
Preferred Phone		 Last Name
UR Extension
Dept./Division
 
Please hide my e-mail address when sending e-mails to the group
I wish for all my information to be kept strictly confidential
 
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