To become a member of the Chicago Bridge and join the Google Group listserv please complete the following membership form. The information collected in this form helps the Chicago Bridge better meet the needs of all members. Once you have submitted the form you will hear from the Chicago Bridge Membership Director regarding your status and more information about how to get involved in the Chicago Bridge. If you have any questions or concerns about this process please email
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First Name: *
Last Name: *
Organization or School Affiliation *
Home Address:
Zip Code
Email Address *
Phone Number
What is the highest level of education you have completed? *
What is your current field? *
For example, Nursing, Social Work Student, Geriatrician, Etc.
What is the job title for your current position? *
Membership Level *
Which locations are convenient for you to attend Chicago Bridge Monthly meetings? *
Check all that apply
Are you able to be a Refreshment or Location Sponsor?
Refreshment sponsors provide simple foods and beverages for our events, Location sponsors orchestrate the physical location of events and work closely with the Events Director to ensure event space is appropriate for programming
Google Group Email Preference
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