Membership Application

First Name: Last Name: Membership Level: Email: Mobile: Home Address: City: State: ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING AMERICAN SAMOA FEDERATED STATES OF MICRONESIA GUAM MARSHALL ISLANDS NORTHERN MARIANA ISLANDS PALAU PUERTO RICO U.S. MINOR OUTLYING ISLANDS VIRGIN ISLANDS ARMED FORCES AMERICAS ARMED FORCES ARMED FORCES PACIFIC ALBERTA BRITISH COLUMBIA MANITOBA NEW BRUNSWICK NEWFOUNDLAND AND LABRADOR NOVA SCOTIA NORTHWEST TERR. NUNAVUT ONTARIO PRINCE EDWARD ISLAND QUEBEC SASKATCHEWAN YUKON Zip: - What is your work zip code? Birth Date: / / Gender: Female Male Other What is your ethnicity? Highest level of education completed? High School or GED Equivalent Trade School/Technical School Some College Undergraduate Degree Graduate Degree Doctoral Degree Marital Status? Single Married/Partner Widowed/Divorced Other What industry are you in? Administrative Support Agriculture Architecture Arts Community and Social Services Computer Sciences Construction Education Engineering Entertainment Entrepreneur Finance Health/Wellness Hospitality Legal Management Manufacturing Marketing Media Medicine Mental Health Military Non-Profit Sales Service Industry Sports Transportation Other Name of Employer? Other organization / association / non-profit involvement? How did you get to San Antonio? Transplant (moved from another city) Boomerang (lived in SA previously and moved back) Native (SA born and raised) If applicable, what city did you move from? How did you hear about LOOP? Social Media Internet Search Friend Event Work Organization Other What San Antonio issues are important to you? Why do you want to be a member of LOOP? What committee are you interested in?