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* 1. First name

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* 2. Last name

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* 3. Company

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* 4. Address

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* 5. Address 2 (if needed)

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* 6. City, state, zip

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* 7. Cell Phone

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* 8. Work Phone

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* 9. Email

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* 10. Were you recommended to apply by a past Leadership Minnesota participant?

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* 11. Current employer

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* 12. Title

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* 13. Responsibilities

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* 14. Previous employer

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* 15. Title

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* 16. Responsibilities

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* 17. What outside organizations have you volunteered or been engaged with and how did you contribute?

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* 18. In your opinion, what are the three most significant policy issues facing business in the state of Minnesota and why?

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* 19. You will spend five, two-day sessions as part of a group of 35 business leaders from across the state. You will be touring different companies and talking with our state's business and political leaders. What do you expect to gain from this experience?

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* 20. What previous engagement have you had with the Minnesota Chamber?

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* 21. What qualities will you bring to the group?

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* 22. We want to know who you are! Tell us something interesting about yourself. 

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* 23. Reference
Name

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* 24. Title

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* 25. Company

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* 26. Phone

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* 27. Email

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* 28. To get the most out of this experience, it is important that you attend all five sessions. Do you commit to attending all five sessions in their entirety?

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