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MERGE - I'd like to participate!

 

1. Please enter the following information:

Please enter the following information:   First Name:
Last Name:
Agency/Company:
Title:
City/Town:
State:	-- select state --AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming
Email Address:
Phone Number:

2. I would like to participate in the following MERGE Employee Resource Groups: (check all that apply)

I would like to participate in the following MERGE Employee Resource Groups: (check all that apply)   Asian Heritage Group Black Employee Network IPGLBT SOMOS-Hispanic/Latino Heritage Group WLN-Women's Leadership Network

3. I would like to participate in the following MERGE Action Committees: (check all that apply)

I would like to participate in the following MERGE Action Committees: (check all that apply)   Careers Committee Connections Committee Growth Committee Metrics Committee

4. I would like to participate in the following ways: (choose all that apply)

I would like to participate in the following ways: (choose all that apply)   Ambassador Event Planner Project Manager Writer Creative Director	Blogger Networker Account Planner Reseacher Client Services	Accountant Meeter & Greeter Technology IT Photographer
Other (please specify)