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First name
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Last name
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Email
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Phone number
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Gender Pronouns
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She/Her
They/Them
He/Him
Other
Ethnicity
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Black or African American
West Indian or Caribbean
African
Afro-Latine
Not of The African Diaspora
City
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State/Region
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2 letter abbreviation
Hometown
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Job title
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Company name
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Professional Level (or Equivalent)
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Please Select
Early Career (Less than 5 years)
Mid-Career (5-10 years)
Senior Level (10-15 years)
Executive Level (C-Suite Level, President, Founder, etc.)
Industry Category
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Agriculture, Forestry, Fishing and Hunting
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Biotech
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Diversity Equity Inclusion
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Faith & Leadership
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Must Submit a link to at least one of your (public) social media accounts or a photo of your ID.
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Why are you interested in joining Boston While Black?
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Birthday
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How Did You Hear About Boston While Black?
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What Best Describes You?
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Select All That Apply:
Recently Moved to the Boston Area
Long-Time Transplant
Grew Up in Boston
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How Are You Planning to Utilize this Community?
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Digital Community Platform
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Access to Discounts + Free Perks
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Looking for Black Owned Businesses, Events, Resources to Support
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