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.
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):

Alumni CommitteeCurriculum CommitteePrograms and Development CommitteeClass Selection Committee
Please select any area(s) of interest for volunteering:

Board of DirectorsMentoringEvent PlanningMarketing/CommunicationsCurriculum FacilitationOther
Personal & Additional Information
How would you like to receive communications from LSR? (select all that apply)

EmailPhoneTextSocial MediaOther
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

Alumni Information

Leadership Santa Rosa Program Details

Professional Information

Engagement & Interests

Personal & Additional Information