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your you do

First Name *

Surname *

Pronouns *

Email Address *

Phone Number *

Zip Code *

What is the highest level of education you have completed? *

Some High School or Less
High School Degree
Some College
2-Year College or Technical Degree
4-Year College or Technical Degree
Graduate Degree or Professional Degree

Age Group *

18-24
25-34
35-44
45-54
55+

What was your sex assigned at birth? *

Male
Female
Intersex
Prefer not to answer

Which of these bests describe your current gender identity? *

Cisgender male/man: Your gender identity (male/man) matches the sex you were assigned at birth
Cisgender female/woman: Your gender identity (woman/female) matches the sex you were assigned at birth (female)
Genderqueer, gender non-binary, or gender fluid: Your identity does not correspond to conventional binary gender distinctions (I.e. man/woman).
Transgender male/man: Your gender identity is man/man and you were assigned female at birth
Transgender female/woman: Your gender identity is female/woman and you were assigned male at birth
Prefer not to answer

Which of these bests describe your current sexual orientation? *

Gay: Sexually oriented toward people of the same gender, usually binary gender
Straight: Sexually oriented toward people of a different gender, usually binary, gender
Lesbian: Women who are sexually oriented toward other women
Bisexual: Sexually oriented toward both men and women
Queer: Sexually oriented toward people of more than one gender
Pansexual: Sexually oriented to people of any gender
Questioning: Uncertain about sexual orientation identity
Other
Prefer not to answer

Which of the following do you feel best describe your origin or heritage? (Please mark all that apply)

African American or Black
Afro-Caribbean or West Indian
African
Afro-Latino/Black Hispanic
White Not Hispanic or Latino
White Hispanic or Latino
Asian
Indigenous American/American Indian/Alaska Native
Native Hawaiian or Pacific Islander
Don't know
Other origin or heritage

How did you hear about this event? *

Social media
Friend/Colleague
Email
Newsletter
Community Organization
Other

Health and Wellness Interests: What areas of health & wellness are you most interested in? (Select top 3)

Mental Health & Therapy
Sexual Health & HIV Prevention/Treatment
Physical Fitness & Nutrition
Hormone Therapy & Trans Healthcare
Relationships & Intimacy
Spiritual & Emotional Well-being
Financial Wellness
Aging & Longevity

Engagement & Networking: Are you interested in networking opportunities during the summit? *

Yes
No
Maybe

Engagement & Networking: Would you be open to participating in a focus group, panel discussion, or testimonial sharing? *

Yes
No
Maybe

Summit Experience & Accessibility: Have you attended a health summit focused on Black LGBTQ+ men before? *

Summit Experience & Accessibility: What format do you prefer for workshops/panels? (Select all that apply)

In-person sessions
Virtual sessions
Interactive Q&A panels
Hands-on activities

Email

PPRATT@MALENESSS.ORG

Phone

773-296-2400

ADDRESS

2835 N SHEFFIELD, CHICAGO, ILLINOIS 60657

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Health and Wellness Summit for Black Gay, Bisexual, and Transgender (GBT) Men! A 501 (c)(3) organization and a subsidiary of Wellness Homes of Chicago, Baal Perazim Wellness, Inc.

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Home
About Us
- 8 Core Themes
- Our Team
Upcoming Events
News and Media
- Press Releases
Malenesss Summits
- 2025 Malenesss Summit
  - Malenesss Summit 2025 Images
  - Malenesss Summit 2025 Videos
- 2026 Malenesss Summit
  - Registration
  - Agenda
Become A Sponsor
Contact Us
Donations

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