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* 1. Please provide your full name.

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* 2. What company do you work for, where is it located, and what is your title there?

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* 3. Please provide your email address and phone number.

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* 4. Please provide a link to your LinkedIn profile.

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* 5. Please tell us about your company and include a link to the website.

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* 6. Which chapter(s) are you interested in joining? (Click all that apply)

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* 7. Which membership level(s) are you interested in?

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* 8. Why would you like to join a BUILT chapter? What do you hope to gain from becoming part of the BUILT community?

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* 9. Is there anything else you would like to share about yourself, your company, or your interest in BUILT?

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