LSR Alumni Information Survey

Leadership Santa Rosa Alumni Survey
As Leadership Santa Rosa transitions to an independent non-profit, we are updating our alumni database. Your accurate information is vital to our success, allowing us to keep you informed of alumni events, volunteer opportunities, and program news.
Alumni Information
Full Name

First NameLast Name
Name During Program (if different)

First NameLast Name
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Email
example@example.com
Phone Number (Mobile preferred)
Please enter a valid phone number.Format: (000) 000-0000.
Leadership Santa Rosa Program Details
LSR Class Number (e.g. Class 29)
Graduation Year
Company/Organization you represented during your LSR class
Professional Information
Current Employer/Organization
Job Title
Industry
Engagement & Interests
I am interested in learning more about the following committee(s):
Please select any area(s) of interest for volunteering:

Other
Personal & Additional Information
How would you like to receive communications from LSR? (select all that apply)

Other
Birth Date (month and day only for birthday greetings)

MonthDayYear
Privacy Statement: Leadership Santa Rosa values your trust and is committed to protecting your privacy. We treat your information as confidential. We will not sell your personal data to any third party.
Should be Empty:

Leadership Santa Rosa Alumni Survey