[raw]Step 1 of 333%First Name*Please include your legal first name.Middle InitialPlease include your legal middle initial.Last Name*Please include your legal last name.Preferred NamePlease include your preferred full name, if applicable.How old were you when you attended conversion therapy?Under 1818-2425-3435-4445-5455-6465 or AbovePrefer Not to AnswerPlease state your age at the time you attended conversion therapy.When did you first attend conversion therapy?*Please identify when you first started attending conversion therapy.How long were you in conversion therapy?*Please identify how long you were in conversion therapy.Where did you attend conversion therapy?*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingPlease identify the location you attended conversion therapy.Did you voluntarily attend conversion therapy?*YesNoWould rather not sayPlease state whether your conversion therapy experience was voluntary or not. Why did you attend conversion therapy?*e.g., forced by your parents; pressured by peers or friends; etc.Share your story!*Please talk about your conversion therapy experience.What harm did conversion therapy cause?*Please explain all the harmful effects that you experienced after or while attending conversion therapy.What positive experiences came out of attending conversion therapy?*Please explain any positive experiences that occurred while attending conversion therapy.Why or how did you leave conversion therapy?*Please explain what caused you to leave conversion therapy.What helped you to overcome your experience while attending or after attending conversion therapy?*Please explain what helped you overcome your experience during or after attending conversion therapy. What information would you like to share that was not covered in the questionnaire?Please state any information you would like to share that was not covered in the questionnaire.What is your phone number?*Email Address*Please give us your email address.****NOTE**** You will not be contacted if you do not wish to be contacted.Can we contact you via email if we have any questions about your experience?*NoYesPlease state whether it is alright to contact you with further questions.Would you like to take part in an educational video on the topic of conversion therapy?*yesNoPlease state whether you would like to contribute to spreading awareness and educating people about the effects of conversion therapy.Parent / Guardian First Name*Please state your parent / guardian's legal first name.Parent / Guardian Last Name*Please state your parent / guardian's legal last name.Parent / Guardian Email AddressPlease state your parent / guardian's email address. This iframe contains the logic required to handle Ajax powered Gravity Forms.