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New Member Information
Please complete this form to be considered for membership in an ADVANCE Leadership Roundtable
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Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Title
*
Your answer
Phone
*
Your answer
Company Name
*
Your answer
Company Street Address
*
Your answer
Company City
*
Your answer
Company State
*
Your answer
Company Zip Code
*
Your answer
Industry
*
Manufacturing
Tech
Logistics
IT/Technology
Construction
Service
Healthcare
Transportation
Hospitality/Restaurants/Entertainment
Professional Services
Non-Profit
Other:
Functional Area
*
Finance
Management
Marketing
Legal
HR / Staffing
Leadership
Government Contracts
Sales
Other:
Required
Company Size
*
1-19 Employes
20-95 Employees
96-160 Employees
161-350 Employees
351+ Employees
Meeting Preference
*
In-Person
Virtual
Hybrid
Required
Social Networks Used (click all that apply)
*
Facebook
LinkedIn
Instagram
Twitter
TikTok
Other:
Required
Preferred Contact Method
*
Email
Text
Phone Call
Required
Because we need 8-12 members to start a table in a location, please list people in your network (with contact info) that you would like to add to your table. (Optional)
Your answer
What value do you hope to gain from participation in a leadership roundtable?
Your answer
Comments
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