Your Name

Your Email

Phone

Address

Birthdate (mm/dd/yy)

Marital Status

# of Children and Ages

Are you an entrepreneur?

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Describe your business or occupation.

What compelled you most about joining the MPMC?

In what area are you most looking for support right now?

What 1-3 goals do you have for yourself right now (personal or professional)?

What's your personal or professional vision for where you'd like to be in the next 1-5 years?

What are your greatest strengths?

What areas are you aware of that you need to work on?

How do you see yourself contributing to other members and the community of MPMC?

What would be the greatest result you could get from participating in the MPMC?

Is there anything else you would like me to know?

Please enter the letters/numbers you see below.

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