The 2009 National GLBT Veterans Census

1) Service Component: (check all that apply)
 Army Navy Air Force Marine Corps Coast Guard

 Army Reserve Navy Reserve Air Force Reserve Marine Corps Reserve

 Army National Guard Air National Guard Service Academy ROTC

2) Highest Rank Attained:

3) Total Time in Service: (years) (months)

4) I left the military in... (year)

5) I identify as...  Gay Lesbian Bisexual Transgender

6) Zip Code: + (if known)

7) Email:

(Your email address will only be used to help ensure that your information is only counted once and not submitted or recorded in duplicate. It will NOT be shared with any outside party!)