Tell Us About You!

Association of Women Professionals --

Tell Us About You!

| | | | | | | | | | | | | | | | | | | | |

We would love to know more about our web site visitors. All individual information will be kept confidential -- statistics will only be given out in an aggregate form. Under no circumstances will your contact information be sold or given to a third party. Please take a moment to complete our survey.

Association of Women Professionals

Name:

Address:

City: State: Zip Code:

Phone:

Email:

Membership Status:

Member
Non-Member

Gender:

Female
Male

Age (select one):

Under 18 years old
18 to 21 years old
22 to 25 years old
26 to 35 years old
36 to 45 years old
46 to 55 years old
56 to 65 years old
Over 65 years old

Highest Level of Education (select one):

Did not complete High School
High School Diploma
Associates Degree (2 year college degree)
Bachelors Degree (4 year college degree)
Masters Degree
Doctorate Degree (PHD, JD, MD, etc)

Job Function (select one):

Unemployed
Stay at Home Mom
Analyst/Staff
Independent Consultant/ Self-Employed
Manager/Supervisor
Executive
Business Owner
Retired
Other, please specify

Number of Employees at your Company (select one):

9 or less
10 to 49
50 to 99
100 to 499
500 to 999
1000 or more

Household Income (select one):

0 to $20,000
$21,000 to $35,000
$36,000 to $50,000
$51,000 to $75,000
$76,000 to $100,000
$101,000 to $150,000
Over $150,000

We are considering starting local chapters of the Association of Women Professionals. Would you be interested in joining a local chapter in your area?

Yes
No

If yes, please specify the best location for a local chapter near you

Location (City, State):

How did you hear about us? (please specify)

Comments:

(You may also print out this page and mail it to the address below)
Association of Women Professionals, P.O. Box 5560, Chicago, IL 60680

Association of Women Professionals * PO Box 5560 * Chicago, IL * 60680