Access Volunteer and Outreach Registration Form

Pride Buffalo, Inc. is committed to promoting the full participation of all members of the gay, lesbian, transgender and bisexual communities in our celebration. With pride, we announce the creation of the Access to Pride Committee. The Committee is dedicated to providing services to those amongst us in celebration who may be deaf or hard-of-hearing, facing barriers to participation due to age or physical ability, or in need of on-site support in "coming out."

We'd like to count you in, and ensure that everyone has an opportunity to participate in and celebrate Pride Month! Your response is essential to the successful planning and delivery of Access Services in 2007.

If you could benefit from our Access Services, or if you are interested in becoming an Access Committee volunteer, please let us know. You can contact us by submitting the form below. If desired, you can print and complete this form, and return it to Pride Buffalo, Inc. 266 Elmwood avenue, Suite 207, Buffalo NY 14222. If you have any questions or concerns, you can leave a voice message at our dedicated Pride Buffalo phone line, (716) 559-3800.

Your Name *

Address

City

State

Zip/Postal Code

Preferred Phone Contact # *

Best Time to Contact

Your E-mail *

Services Required (Please Check)	Volunteer Interests (Please Check)
Deaf or Hard-of-hearing services Physical access services Emotional support services	Deaf or hard-of-hearing services Physical access services Emotional support services

* = Required Field

Please note that a brief orientation will be offered to and required of all Access Committee Volunteers. Only certified mental health professionals will be allowed to offer emotional support services.

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Pride Buffalo, Inc.

266 Elmwood Avenue, suite 207

Buffalo NY 14222
(716) 559-3800