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First name
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Last name
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Email
*
Company name
*
(if not available type: n/a)
Company domain name
For example, NCBA CLUSA's company domain (website address) is = https://ncbaclusa.coop/. If you don't have a domain, you can use https://ncbaclusa.coop/ or leave blank
Job title
*
You are welcome to use n/a if not applicable
Work Title Code
Please Select
00-Inactive-Former-Retired-Employee
01-Active Retired/Emeritus
02-Active-In Transition
03-Deceased-InMemoriam
10-CEO/GM
11-C-Suite
12-Board of Directors
13-Emeritus CEO/Chair
19-Admin
20-VP/EVP/SVP
25-Chief of Party
30-Professional (Lawyer, Professor, Accountant)
40-Director
45-Consultant
50-Mgr/Coord/Spec
60-Intern / Fellow / Student
70-Member-Owner
98-NonSpecified/UNKNOWN
99-Z-Generic Email
How did you hear about this event?
Co-op Weekly
Co-op Circle
Email
From a colleague/board member
From a friend
From NCBA CLUSA staff/team member
Other
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