ICTUP Member Information

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Phone Number* This field is required.
Please enter a valid phone number.
4
Pronouns
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Large
Normal
Small
Ok
Ok
5
Can we share your contact info with other Urban Professionals?* This field is required.
YESNO
6
Can we share you contact info with organizations looking for board members and/or job sharing opportunities?* This field is required.
YESNO
7
Gender (please select all that apply)* This field is required.
Female
Male
Gender Non-Conforming/Gender Queer
Transgender
Prefer not to say
Other
8
Which of these best describes your race/ethnicity? (please select all that apply)* This field is required.
African American/Black
Asian - Pacific Islander
Hispanic/Latino and/or Spanish
Biracial/Multiracial
Native American/Alaskan Native
Native Hawaiian
White
Prefer not say
Other
9
What is your age?* This field is required.
18 - 25
26 - 34
35-40
41-45
Prefer not to respond
Other
10
Place of employment
11
Current University/College
12
Please list all organizations that you have active membership status (i.e. SHRM, Black Nurses Association, NPHC, etc.)
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Large
Normal
Small
Ok
Ok
13
Can we feature you as a member of the organization on website, social media, and print material?* This field is required.
YESNO
14
T-Shirt Size* This field is required.
Small
Medium
Large
XL
2XL
3XL
4XL
5XL
Other
15
Please upload your headshot
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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16
Would you like to join the ICTUP Leadership Squad?* This field is required.
YESNO
17
My Products* This field is required.
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My Bag
0
My Bag
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
ORDER SUMMARY
Total costUSD
ICTUP General MembershipICTUP Membership annual dues. Purchased members gives you access to members only events and discounted opportunities.
$50.00Edit
Back
ICTUP Undergraduate College Student MembershipICTUP Membership annual dues. Purchased members gives you access to members only events and discounted opportunities.
$15.00Edit
Back
ICTUP Graduate College Student MembershipICTUP Membership annual dues. Purchased members gives you access to members only events and discounted opportunities.
$20.00Edit
Back
Enter Coupon
Total cost $0.00
Credit Card
First Name
Last Name
18
Invoice ID
Should be Empty: