2024-2026: BPS Interest Form
Please fill out this form so we can get to know you! The membership chair will reach out within 24-48 hrs
Name
*
First Name
Last Name
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Highest level of education
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HS Diploma
Bachelor Degree in progress
Bachelor Degree
Master's Degree
Other Advance Degree
Where do you live?
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NYC Area
Nassau County
Suffolk County
Other
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