Conversion Therapy Story Collection

Tell us your story.

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Contact Information

First Name Last Name

Date of Birth (Optional) Pronouns (Optional)

Gender (Optional) Sexual Orientation (Optional) Race (Optional) Ethnicity (Optional)

Street Address (Optional) Address Line 2 (Optional)

Country (Optional) Postal Code (Optional) City (Optional) State/Province (Optional)

Email Home Phone (Optional) Mobile Phone (Optional)

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Share Your Story

Story Title (Optional)

Your Story

Terms

I am at least eighteen years old.
I confirm that I have written my submission. If my story includes details about anyone else, I confirm that I have permission to share such details.
I declare that the information provided by me is true and accurate to the best of my knowledge.
I am willing to have my story shared publicly.

I confirm that my story can be used by the organization