Membership Application

Membership Level: First Name: Last Name: Email: Cell Phone: Work Phone: Home Address: Address Line 2 City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Zip: - Zip Suffix Company Job Title Industry Which of the following closely matches your job level? Director Senior Executive Manager/Contributor Entrepreneur/Consultant/Independent Contractor C Suite In Transition Other Organizations revenue Less than $100,000 $100,000 to <$1 Million $1 Million to <$10 Million $10 Million to <$100 Million $100 Million or more Office location The city of Minneapolis, MN Minneapolis suburbs The city of St. Paul, MN St. Paul suburbs Other (not listed) LinkedIn Profile URL Age Under 25 years old 25-34 years old 35-44 years old 45-55 years old more than 55 years old Ethnicity American Indian/Native American Asian/Pacific Islander Black/African American Hispanic/Latino White/Caucasian Muilti-racial Other (not listed) Prefer not to answer Do you belong to any additional business-related professional organizations? Yes No Reason for Joining? How did you hear about us?