Civil Unions Don’t Work.com, a video website of Garden State Equality

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<% if not isempty(Request.Form("submit")) then Name_ = Request.Form("Name") Partner_ = Request.Form("Partner") Hometown_ = Request.Form("Hometown") Email_ = Request.Form("Email") Phone_ = Request.Form("Phone") AltPhone_ = Request.Form("AltPhone") BestTime_ = Request.Form("BestTime") EntityName_ = Request.Form("EntityName") Problem_ = Request.Form("Problem") submit_ = Request.Form("submit") info = "Name : " & Name_ & chr(13) & "
" info = info + "Partner's Name : " & Partner_ & chr(13) & "
" info = info + "Hometown : " & Hometown_ & chr(13) & "
" info = info + "Email : " & Email_ & chr(13) & "
" info = info + "Daytime Phone : " & Phone_ & chr(13) & "
" info = info + "Evening or Mobile : " & AltPhone_ & chr(13) & "
" info = info + "Best time : " & BestTime_ & chr(13) & "
" info = info + "Entity Name : " & EntityName_ & chr(13) & "
" info = info + "Problem : " & Problem_ & chr(13) & "
" Set objCDOSYSMail = Server.CreateObject("CDO.Message") objCDOSYSMail.From = Request.Form("Email") objCDOSYSMail.To = "Contact@GardenStateEquality.org" objCDOSYSMail.Subject = "From the Civil Unions Don't Work website: Civil union situation" objCDOSYSMail.HTMLBody = info objCDOSYSMail.Send 'Close the server mail object Set objCDOSYSMail = Nothing Set objCDOSYSCon = Nothing %>

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<% else %>
What's your situation?

If you and your partner have gotten a civil union in New Jersey and have run into a problem getting your civil union recognized – whether by an employer, hospital or any other institution – we at Garden State Equality want to know. We may be able to help. Please fill out the form below and a member of our staff will get back to you. You may also call Garden State Equality at (973) GSE-LGBT.

All information is strictly confidential. We will not release this information to third parties without your permission.

Name:

Partner’s name:

Hometown:

Email:

Daytime phone:

Evening or cell phone:

Best time to reach you:

Name of entity that is discriminating:

Problem you have faced (not more than 200 words):

© 2008 Garden State Equality. All rights reserved.
Contact@GardenStateEquality.org 973.GSE.LGBT