Full Name*

Email Address

Title*

Department*

Company*

Work Number*

Cell Number*

Your Business or Organization's Industry*

Is your company a current member of the Chicagoland Chamber?*

How would you describe your current career stage?

Are you currently a Council Member for Emerging Leaders?

If yes, would you like to continue serving on the EL Council?

It not, are you interested in serving on the EL Council?

Are you interested in hosting an Our Seat at the Table or a Fireside Chat?

What do you personally hope to get out of the Emerging Leaders program?

LinkedIn Page

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Additional Links (i.e. personal website, blog, published content, or other webpages that are representative of you?)

Is there anything else you'd like share? Questions, comments, feedback, concerns?

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