Becoming a Member Form

BECOMING A MEMBER FORM

Benefits of Being a Member

"*" indicates required fields

URL

This field is for validation purposes and should be left unchanged.

Name*

Email*

City*

State*

Phone Number

DOB (Month and Day ONLY)

Special / Executive Assistant Contact Name*

Special / Executive Assistant Contact Email*

Chief of Staff Name

Chief of Staff Email

Communications Contact Name

Communications Contact Email

Social Media Handles (X, Facebook, Instagram, LinkedIn)

Mayor's Office Phone Number*

Mayor's Office Address (City, State, Zip Code)*

Fraternity / Sorority / Social Organization

Degrees / Professional Certification

Policy Interest

City Website URL*

Policy Interest

Which invoicing cycle would you prefer?*

Current Fiscal Year (July to June )

Current Calendar Year (January to December )

(The city will be invoiced annually on this schedule unless requested otherwise)

Invoice Contact Name

Invoice Email Address

Please upload a headshot photo for our website (png format preferred)*

Drop files here or

Max. file size: 2 GB.