* 1. What is your first name?

* 2. What is your last name?

* 3. What is your age?

* 4. What is your gender?

* 5. Which race/ethnicity best describes you? (Please choose only one.)

* 6. If you identify with multiple ethnicities, please specify:

* 7. Street Address:

* 8. City:

* 9. State:

* 10. Zip Code:

* 11. Email Address:

* 12. Phone Number:

* 13. Place of Work:

* 14. What is your title?

* 15. Please insert your LinkedIn profile URL:

* 17. How did you hear about Goodcity?

* 18. Was there a different way you heard about Goodcity? We would love to hear about it!

* 19. Are you committed to making a difference in the city?

* 20. Do you want to subscribe to our newsletter?

* 21. Which of the following are you interested in?

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