General Information
Your name:
Your spouse's name:
Your home city and county:
Couple Information
Have you received a legal marriage license in another state or country that recognizes marriage equality?
Yes
No
If so, please let us know when and where:
When you and your spouse married in this jurisdiction, did you reside there?
Yes
No
If so, what year did you move to Maryland?
Have you registered for either a domestic partnership or a civil union?
Yes
No
If so, please let us know when and where:
Have either of you ever been legally married to someone of the opposite sex?
Yes
No
If yes, what years were you married and divorced?
How many years have you been a couple?
What kind of work do you and your spouse do?
Are either of you a city, county or state employee?
No
Yes - city employee
Yes - county employee
Yes - state employee
Your ethnicity (i.e. Caucasian, African American, etc.):
Your spouse's ethnicity (i.e. Caucasian, African American, etc.):
Female
Male
Female
Male
What are you and your partner's religious backgrounds?
Which religion, if any, do you currently practice?
How important is religion/spirituality in your lives?
Are you or your partner a member of the Armed Services or a veteran?
Yes
No
If yes, please tell us which branch, rank and dates served; include any honors:
Family Information
Yes
No
If you have kids, tell us their ages, sex and ethnicity:
If you have kids, are you adoptive or biological parents, or is one of you lacking a legal relationship to your children?
Do you have any grandchildren?
Yes
No
Describe how supportive your families are of your relationship:
Marriage Inequality Issues
Tell us how you, your partner or your children have been harmed because your marriage is not legally recognized in Maryland (i.e. health benefits, hospital visitation, medical decision-making, immigration, death/funeral planning, housing, employment, etc.):
Tell us what health care issues you, your partner or children might have (i.e. can't get medical leave to take care of sick partner/child, health insurance won't cover failing health of partner/child, etc.):
Would you and your partner be interested in speaking to the media, legislators or groups interested in hearing your story?
Yes
No
If yes, please feel free to answer the following questions.
Tell us your hobbies/interests as a couple/family:
Tell us about your relationship (i.e. any interesting story about how you met/what attracted you to each other):
Please send us a digital photo of you and your partner (preferably a close-up image of both of you together, such as an above-the-shoulders head shot). If you have kids, feel free to send a shot of the family together, as close-up as possible.