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Charleston Individual Application
Step 1 of 3
First Name
Last Name
Email Address
Mobile Number
May we contact you via text message?
Yes
No
By selecting yes, you agree to receive text messages from us. Please note that you may be charged additional carrier fees.
Mailing Address
City
State
Select an answer
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Mexico
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
West Virginia
Wisconsin
Wyoming
Zip Code
Birthday
Gender
Select an answer
Female
Male
Nonbinary
Trans
Prefer not to say
Company
Your Title
Industry
Select an answer
Academia
Automotive
Construction
Energy
Fashion
Film/TV
Finance
Government
Hospitality
Journalism
Law
Marketing
Medicine
Music/Radio
Pharmaceuticals
PR
Publishing
Real Estate
Recruitment
Retail
Sports
Tech
Visual Arts
Other
Retired
Your LinkedIn URL
Please include the full URL. If you don't have a LinkedIn account, please type "N/A."
Are you currently a member of any other clubs or boards? If so, please list them; if not, please type "N/A."
If you were referred by someone, what is their name?
Please provide a short bio.
Please upload a recent photo. (JPG or PNG)
Maximum upload size 10MB.
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