URBAN LEAGUE OF LOUISIANA YOUNG PROFESSIONALS MEMBERSHIP – NOLA

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Date:

CONTACT INFORMATION

First Name
Last Name
Street Address
City
State
Zip
Phone
Email

SOCIAL MEDIA INFORMATION

LinkedIn
Twitter
Instagram
Website
How did you hear about NOLAYP?
If other, please specify

GETTING INVOLVED

Please check what committee(s) you are interested in
What skills do you want to showcase?
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What (current) skills do you want to grow?
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What affiliations do you have?(e.g. board service, community organizations, leadership positions, etc.)
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What programs and/or events would you like to see NOLAYP implement?
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DEMOGRAPHICS
In order for us to better serve you, please fill in/check the applicable areas

Date of birth
Current employer
Job Title
Education
Name of College/University (Undergraduate)
Name of College/University (Graduate)
Sex
Ethnic Background
Age
Marital Status

PROCESSING YOUR MEMBERSHIP DUES

ItemQtyTotal
YP Membership150.00
Annual Charge $xxx

Once you hit submit you will be taken to the PayPal website to complete your membership payment.  Thank you!

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