UB LGBTQ FSA Membership Form

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UB LGBTQ Faculty and Staff Association Membership Application
September 2024 - August 2025

Complete this application form to become an active member of the University at Buffalo LGBTQ Faculty and Staff Association. After completing this application you will immediately be redirected to the online UB Marketplace Store to pay $30 membership dues.

* denotes a required field.

First Name *

Last Name *

Pronouns

They, Them, Theirs
He, Him, His
She, Her, Hers
Self-Identify (please specify)

UB Email *

Campus Mailing Address *

Campus Phone Number *

Primary Office or Department Name *

Primary Title *

With which role do you primarily identify? *

Part-Time Faculty
Full-Time Faculty
Part-Time Staff
Full-Time Staff
Retired Faculty
Retired Staff
Other (please specify)

On which campus do you primarily work?

North
South
Downtown
Remote work only

Years of employment at UB:

Why did you decide to join the LGBTQ FSA? (Select all that apply)

To represent LGBTQ visibility on UB’s campus
To provide advocacy and support for the LGBTQ faculty/staff experience at UB
To provide advocacy and support for the LGBTQ student experience at UB
To attend social events
To attend events that focus around LGBTQ topics
To network within the LGBTQ community at UB
To contribute to LGBTQ initiatives on campus.
Other (please specify)

Member input is important to advancing the strategic plan of the LGBTQ FSA. Would you like to be considered for participation in any future committees that are formed as part of the LGBTQ FSA?

Yes, please contact me when these opportunities are available.
No thank you.

Members agree to the purposes stated in the Association's constitution. *

I agree

Funds have been set aside to fund memberships for faculty and staff who might not have the financial means to purchase a membership for themselves. Would you like our membership coordinator to reach out to you about having your membership covered by these funds?