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Thank you for your interest in South East London Mind (SEL Mind)'s LGBTQIA+ peer support group: Queer Minds Online for both Lambeth and Southwark. Visit our website (selmind.org.uk/queermindsls) for more details.

If you would like to register your interest to attend the Online Queer Minds sessions, please complete this form.

Please note that all fields with a red * are compulsory and must be completed before you can submit this form.

Identity

Forename

Surname

Date of birth

Address

Address 1

Address 2

Town

Post Code

Where do you live?

Contact

Mobile

Emergency contact details: Please include full name, relationship to you, phone number(s) and email address

Dietary requirements

As we provide refreshments, please let us know if you have any allergies or dietary restrictions that we should be aware of

Accessibility Needs

Please let us know any accessibility needs you may have for attending the group

Your requirements

Please share with us why you would like to join our Queer Minds peer support group. Feel free to share as much or as little as you would like.

Referral Information

Referral Source

How did you hear about us?

Queer Minds Online Group (Lambeth and Southwark)