LGBTQ+ Inclusion in Canadian Blood Donation

Name*

First NameLast Name

Pronouns*

Email*

example@example.com

Phone Number

Please enter a valid phone number.

Postal Code

Gender Identity

Please let us know of any accessibility needs or disability accommodation requests that you have:

How would you like to participate?*

ZoomIn person at The 519

How did you find out about this program?

Notice of Collection

The personal information on this form is collected under the authority of the City of Toronto Act, S.O. 2006, Schedule 11, Chapter A, s. 136 (b) & (c) and will be used for the delivery of The 519’s programs and services. The 519 will not use or disclose personal information beyond the scope defined in the program parameters in this form, in accordance with Municipal Freedom of Information and Protection of Privacy Act (MFIPPA). Questions about this collection can be directed to the Privacy Officer at The 519, 519 Church Street, Toronto, ON, M4Y 2C9 by e-mail at Privacy@The519.org or by phone at 416-392-6874.