HLSA of North Carolina Membership Participation Survey

* 1. What is your first name?

* 2. What is your last name?

* 3. HLS Class Year

* 4. Please provide the following BUSINESS CONTACT information.

* 5. Please provide the following HOME CONTACT information (Optional).

* 6. Cell phone number

* 7. Which email address do you prefer we use?

* 8. Which telephone number do you prefer we use?

* 9. How would you like to be involved in the HLSA of North Carolina? (Please check all that apply.)

* 10. If you indicated above that you are interested in being either a leader or member of a shared interest group, which of the following shared interest groups would be of interest to you? (Please check all that apply, suggest others.)

* 11. List below all activities that you think HLSA of North Carolina should undertake.

* 12. Suggestions/Comments