Contact Details

Title

If you selected “prefer to self-identify”, please type in your title below:

We ask for your legal name for our reporting requirements, however we will only ever refer to you by your preferred name"

Preferred Name

First Name

Last Name

Phone

Pronouns

They/ThemShe/HerHe/HimShe/TheyHe/TheyXe/XemZe/HirEy/EmAny PronounsMy NamePrefer to self-identify

If you selected “prefer to self-identify”, please type in your pronouns below:

Address Line 1

City

State

Postal Code

Demographic Informaiton

We ask for the following information for the purposes of helping us use the most respectful language when addressing you, understanding our membership population better, and fulfilling our grant reporting requirements. Please note all responses in this section are optional

With which communities do you align/identify? Please select all which apply.

Trans or Gender DiverseLGBTIQ+Intersex, or with innate variations of sex characteristicsBlack, Indigenous, and/or Person of ColourIndigenous, First Nations, Aboriginal, and/or Torres Strait Islander/ZENADTH KESCulturally and Linguistically DiverseDeaf/hard of hearingBlind/low visionNeurodiverseLiving with a disability/DisabledUnder 18Under 25Over 60Parent/family member of a Trans or Gender Diverse person

Do you speak or sign any language(s) other than English? If so, please list below.

Membership Information

Transgender Victoria is pleased to offer a range of memberships to suit your needs. Please select which membership type you would like to register for below.*

Payment Information

Name on Card

Card Number

CVC Code

Billing Email

Contact Information