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Membership Survey
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* Indicates required question
Name
*
Enter your name
Your answer
Phone
Your answer
Organization
Your answer
Email Address
something@something.org
Your answer
Street Address
1234 Main Street
Your answer
City
Microscopolis
Your answer
State
Maryland
Your answer
ZIP Code
12345
Your answer
What year did you first join the Society?
How long have you been affiliated?
Your answer
Why are you a member?
What are you here for?
Attend lectures
Present or show poster
Food and drinks
Camaraderie
Learn about new products and services
Networking
Learn new techniques
Don't know
Seeking employment
Seeking employees
Other:
Membership type
Are you a student, regular member or sponsor?
Student (Institution)
Regular
Sponsor
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