Registration

First Name: Last Name: Email: Title: Company: Phone: 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 NOW Member ID Join Date Area of Interest Preferred Social Media Platforms Occupation Age 65+ 55–64 45–54 35–44 25–34 18–24 17 or younger I’d prefer not to answer What is the highest level of school you completed? Some high school coursework High school diploma or equivalent (e.g., GED) Technical or occupational certificate Some college coursework Associate degree Bachelor's degree Master’s degree Doctorate Other including JD/MD/DDS I'd prefer not to answer Household Income Range 0–$32,999 $33,000–$65,999 $66,000–$99,999 $100,000–$149,999 $150,000 or more I'd prefer not to answer Race/Ethnicity If you'd prefer to self-describe your ethnicity, enter here How do you identify? Do you consider yourself a member of the lesbian, gay, bisexual, transgender, and/or queer (LGBTQ) community? Yes No If you would like to self-identify in this community, please enter here. What is your gender? Female Gender Fluid Gender Queer Male Non-binary Transgender I’d prefer to self-identify I'd prefer not to answer If you'd like to self-identify your gender, please enter it here What are your pronouns He/him She/her They/them I'd prefer to self-identify I’d prefer not to answer If you'd prefer to self-identify your pronouns, enter them here Do you want to be contacted for volunteer opportunities? Yes No Skill Set: We encourage you to share your talents. Please list any skill set you think would help our all-volunteer chapter (ex: graphic design, social media, marketing/PR, writing/editing, IT, database management, website design/management, event planning, public speaking, photography, donor relations, etc.). Captcha