Policy Council – Complimentary Registration

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Thank you for engaging with the U.S. Women's Chamber of Commerce. Please complete the form below to register with the U.S. Women's Chamber of Commerce and attend the USWCC Policy Council meeting.

Registration Account Information

*Indicates required field

First Name:*

[MM_Form_Field type='input' name='firstName' customAttributes='placeholder="First Name"']


[MM_Form_Field type='input' name='lastName' customAttributes='placeholder="Last Name"']


[MM_Form_Field type='input' name='username' customAttributes='placeholder="User Name"']


[MM_Form_Field type='input' name='email' customAttributes='placeholder="Email Address"']


[MM_Form_Field type='input' name='password' customAttributes='placeholder="Password"']


[MM_Form_Field type='input' name='phone' isRequired='false' customAttributes='placeholder="Phone Number"']

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Business/Organization Details

Business/Organization Name:* [MM_Form_Field type='custom' id='10' isRequired='true' class='']

Title: [MM_Form_Field type='custom' id='7' class='']

Address: [MM_Form_Field type='custom' id='11' class='']

City:* [MM_Form_Field type='custom' id='12' isRequired='true' class='']

State:* [MM_Form_Field type='custom' id='13' isRequired='true' class='']

Zip:* [MM_Form_Field type='custom' id='14' isRequired='true' class='']

Country: [MM_Form_Field type='custom' id='17' class='']

Phone: [MM_Form_Field type='custom' id='15' class='']

Website: [MM_Form_Field type='custom' id='16' class='']

Industry: [MM_Form_Field type='custom' id='18' isRequired='true' class='']

About Me

I am a:* [MM_Form_Field type='custom' id='21' isRequired='true' class='']

My age range is:* [MM_Form_Field type='custom' id='22' isRequired='true' class='']

Race/Ethnicity: [MM_Form_Field type='custom' id='24' class='']

Education:* [MM_Form_Field type='custom' id='89' isRequired='true' class=''] [MM_Form_Field type='custom' id='94' class=''] I am a Veteran

[MM_Form_Field type='custom' id='90' class=''] I am seeking access to government contracts

My Twitter Handle: [MM_Form_Field type='custom' id='93' class='']

How did you hear about the USWCC?: [MM_Form_Field type='custom' id='23' class='']

Select Councils

[MM_Form_Field type='custom' id='38' class=''] Public Policy

[MM_Form_Field type='custom' id='40' class=''] I Vote for Women

[MM_Form_Field type='custom' id='39' class=''] Young Women

[MM_Form_Field type='custom' id='41' class=''] Career & Workplace

[MM_Form_Field type='custom' id='42' class=''] The Women-Led Economy

[MM_Form_Field type='custom' id='43' class=''] Financial Management & Retirement

Select Policy Issues

[MM_Form_Field type='custom' id='76' class=''] Consumer Financial Protection

[MM_Form_Field type='custom' id='77' class=''] Economy

[MM_Form_Field type='custom' id='78' class=''] Energy

[MM_Form_Field type='custom' id='79' class=''] Fair Pay & Workplace Policies

[MM_Form_Field type='custom' id='80' class=''] Appropriations & Budget

[MM_Form_Field type='custom' id='81' class=''] Government Contracting

[MM_Form_Field type='custom' id='82' class=''] Health Care & Benefits

[MM_Form_Field type='custom' id='83' class=''] Commerce & Trade

[MM_Form_Field type='custom' id='84' class=''] Policy & Politics

[MM_Form_Field type='custom' id='85' class=''] Retirement

[MM_Form_Field type='custom' id='86' class=''] Small Business

[MM_Form_Field type='custom' id='87' class=''] Technology & Communications

[MM_Form_Field type='custom' id='88' class=''] Veterans & Women in the Military

My Address


[MM_Form_Field name='billingAddress' customAttributes='placeholder="Billing Address"']


[MM_Form_Field name='billingCity' customAttributes='placeholder="Billing City"']


[MM_Form_Field name='billingState' customAttributes='placeholder="Billing State"']


[MM_Form_Field name='billingZipCode' customAttributes='placeholder="Billing Zip Code"']


[MM_Form_Field name='billingCountry']

I accept the USWCC terms and conditions.

Register

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