Women in Business Launch Question Title * 1. What is your age? 17 or younger 18-20 21-29 30-39 40-49 50-59 60 or older Question Title * 2. Which of the following best describes your current relationship status? Married Widowed Divorced Separated In a domestic partnership or civil union Single, but cohabiting with a significant other Single, never married Question Title * 3. Which of the following categories best describes your employment status? Employed, working full-time Employed, working part-time Not employed, looking for work Not employed, NOT looking for work Retired Disabled, not able to work Question Title * 4. Are you White, Black or African-American, American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific islander, or some other race? White Black or African-American American Indian or Alaskan Native Asian Native Hawaiian or other Pacific Islander From multiple races Some other race (please specify) Question Title * 5. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305) Question Title * 6. How many people currently live in your household? Question Title * 7. Do you have any children under 18? Yes No Question Title * 8. In a typical week, how many days do you exercise? I don't regularly exercise Once a week 2 to 4 days a week 5 to 7 days a week Question Title * 9. About how long have you been in your current position? Years Months Question Title * 10. Do you rent or own the place where you live? Own Rent Neither (please specify) Question Title * 11. About how many employees work at your company? Question Title * 12. Are you a registered voter? Yes No Unsure / Don’t know Question Title * 13. Which of the following best describes your current job level? Owner/Executive/C-Level Senior Management Middle Management Intermediate Entry Level Other (please specify) Question Title * 14. What types of activities and or skills are you looking to gain from actively engaging with the Women in Business initiative? Supporting entrepreneurs as important contributors to our economy Working with the local community to facilitate the advancement of women in business Mentoring for women to build strong networks and advance careers Supporting military spouses in planning careers and building networks Building formal and informal networks that are critical for career advancement Learning from and networking with women in all stages of their careers Promoting women entrepreneurs and helping improve their business prospects Conducting research with leading institutions to explore women’s business issues and highlight their economic potential Increasing opportunities for women to serve on committees, boards, elected positions, etc. Mentoring women at all stages of their careers Building a network for women entrepreneurs to encourage peer-to-peer networking, education, and professional growth Other (please specify) Question Title * 15. What are the top three topic areas you would like to see presentation on? Question Title * 16. Tell us who you are and how we may contact you Name: Company: Address: Address 2: 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 ZIP: Country: Email Address: Phone Number: Done