Full Name *

First Name

Last Name

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Personal Phone Number

(###)

###

####

Office Phone *

(###)

###

####

Campaign Headquarters Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Campaign Headquarters Phone Number

(###)

###

####

Campaign Headquarters Fax Number

(###)

###

####

Campaign Manager Name

First Name

Last Name

Campaign Manager Mobile Number

(###)

###

####

If endorsed will you display the endorsement of the Stonewall Democratic Club of NYC in your literature whenever you list other endorsements and will you display the endorsement on your website?:

Yes

No

Will you work with the New York State Legislature to support the passage of the Gender Expression Non-Discrimination Act?

Yes

No

Do you support equal rights and treatment for people of transgender experience in the New York Shelter System, both adult shelters and youth shelters?

Yes

No

Do you support full marriage equality for same-sex couples?

Yes

No

Do you support repealing the ban on compensated gestational surrogacy in New York State?

Yes

No

Do you oppose the use of condoms as evidence of prostitution in criminal cases?

Yes

No

Do you support prohibiting licensed New York State therapists from offering so called, “conversion therapy”?

Yes

No

Do you support or oppose permitting religious institutions to use New York City public school buildings for worship services?

Support

Oppose

Will you support increasing the funding for both emergency shelter beds and transitional beds for homeless youth, a huge percentage of whom are from the LGBT community and will you pledge to support capital and expense funding for programs serving this population?

Yes

No

The LGBT community is in great need of senior housing for many of our aging population. Many seniors experience homophobia in senior facilities making them feel they must be closeted. Would you help with the funding of senior housing for the LGBT community?

Yes

No