Galaxe Pride at Work Membership

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 Member Contacts
Chapters

Galaxe Pride At Work is a formal organization for Xerox employees (retired, salaried, hourly or non-direct), who are gay, lesbian, bisexual, transgender, or who support gay, lesbian, bisexual, transgender concerns.  Galaxe Pride At Work's mission is to offer support and visibility within Xerox and beyond to its members, and to provide an official point of contact between its membership and Xerox Corporation, as well as with other gay, lesbian, bisexual and transgender organizations external to Xerox. To apply for membership in Galaxe Pride At Work, complete the following questionnaire. Required information is indicated.

Membership Form

Fields in RED are Mandatory

First Name

 		 Last Name

Nickname

Membership type
Full member (Xerox Corporation employees and retirees in good standing)
 Associate (non-Xerox employees)

Status
Exempt Non-Exempt Contract Union

Organization or Company

Title

Which Division do you belong to? 
How do you classify yourself? (Optional)


Work Information:
Phone: Direct Line
 Phone: Intelnet

Email Address (office or home email is mandatory)

Mail Stop/Location

Address
City
 State/Province:
 Zip/Postal Code

Country


Home Information:

Phone

Email Address

Address

City
 State:
 Zip/Postal Code

 

 

Would you like your name and contact information published on the Galaxe Pride At Work web site?
Yes No

If "Yes", which contact information would you like published?
Job Title
Work Email Address
Work Phone
Work Address
 Home Email Address

Preferred method to receive information:

What Galaxe e-mail distribution list would you like to join?

Would you like to join the Galaxe CHAT e-mail distribution list?
Yes No

If there is a local chapter in your area, you will be joined in order
to facilitate local communications.

Would you like individual emails or a daily digest format?


If there isn't a local chapter, would you be willing to serve as a regional contact person for Galaxe?
Yes No

Hobbies or Special Interests:

How did you find out about Galaxe and what prompted you to join?