Demographics Questionnaire Blank Form (#21)Please complete the questionnaire, and we will update your profile with your demographic information.First NameLast NameEmailAddressAddress Address, Suite, Unite etc (optional)CityStateZip / postal CodeCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)ReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweOrganization- Select -Alberta Health ServicesAlberta School of Employee Benefit PlanAlchemy Communications IncAspen View Public SchoolsAssociation of Alberta Sexual Assault Services (AASAS)Athabasca UniversityBig Hill HavenCalgary Immigrant Women Association (CIWA)Calgary John Howard SocietyCampfire KinshipCanadian Armed Forces Transition CentresCanadian Centre To End Human TraffickingCentre to Empower All Survivors of Exploitation (CEASE)Chinook Sexual Assault CentreCity of EdmontonCity of Medicine HatCity of St. AlbertClaresholmCounty of Grande Prairie No.1County of Grande Prairie No.2Dengarry Professional ServicesDepartment of National DefenceEdmonton Police ServiceFamilies First SocietyFearIsNotLoveGosbee Family FoundationGovernment of AlbertaGreenwood Neighborhood PlaceHintonHomeFront CalgaryIslamic Family and Social Service AssociationJewish Family ServicesKids KottageLadies in the Family FoundationLakeshore Regional Police ServiceLegal Aid AlbertaLethbridge Family ServicesMacEwan UniversityMamowichihitowin Community Wellness ProgramMaxbell FoundationMomentumMosaic PCNMount Royal UniversityMunicipal District of GreenviewNative Counselling Services of Alberta (NCSA)Next Gen MenNorquest CollegeNova Scotia Advisory Council on the Status of WomenOdyssey HousePACE CentrePembina Crisis Connection SocietyThe Regional Municipality of Durham – Public HealthQuorum SoftwareRimbey FCSSRocky view CountyRowan HouseRoyal Canadian Mounted PoliceRural Development NetworkSaffron CentreSagesseSanare CentreSexual Assault Services of SaskatchewanSpruce GroveStudio LumenTerra CentreThe Regional Municipality of Durham – Public HealthThe Today CentreTown of CanmoreTown of Stony PlainTown of Swan HillsUniversity of AlbertaUniversity of Calgary - ShiftUniversity of Calgary - StaffUniversity of Calgary - StudentWaypointsWestern UniversityWJS CanadaWord on the StreetYWCA BanffYWCA EdmontonYWCA LethbridgeOtherOther, please type in your organization.Type of organization- Select -Community Association and/or GroupFunding agency and/or FoundationGovernment – FederalGovernment – MunicipalGovernment – ProvincialNot-for-profit SectorPrivate SectorOtherOther, please type in your response.Current position and/or role in the community- Select -AdvocateBoard MemberConsultantManagerSenior LeaderStaffStudentVolunteerOtherOther, please type in your response.Submit Form