Name *

First Name

Last Name

Phone *

(###)

###

####

Are you an entrepreneur or business owner? *

Yes

No

Do you identify as a member of the 2SLGBTQIA+ community? *

Yes

No

Do you identify with any of the following? *

Please select ALL that apply. We know you're more than a checked box- this information helps Our Landing Place and CGLCC better serve our communities and secure funding for continuing and expanding our programs.

Woman (trans inclusive)

Indigenous

Black

Person of Colour

Global Majority (non-white identity not listed here)

Disabled / Person with Disabilities

Newcomer

Living in a Rural Area

Are you aged 19+? *

Please note, this group is for folks aged 19+ only

Yes

No

Are you a Certified Supplier or Rainbow Registered with CGLCC? *

Yes

No

Which province do you live in? *

Alberta

British Columbia

Manitoba

New Brunswick

Newfoundland and Labrador

Northwest Territories

Nova Scotia

Nunavut

Ontario

Prince Edward Island

Quebec

Saskatchewan

Yukon