Coastal Connections Application

What is your full name? *

What is your email address? *

What is your job title? *

What is your best number? *

What industry are you in? *

How many years of experience? *

What chapter are you interested in joining? *

How did hear about us? *

Have you been a member of a networking group before? *

Yes

No

What motivated you to join our networking group? *

Which days of the week are you available for meetings? *

Do you have any specific skills or expertise you would like to share with the group? *

What do you hope to gain from being a member of our networking group? *

I agree that my details and data will be collected and stored electronically in order to answer my inquiry! *

Agreed