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

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