2. First Name*
3. Last Name*
5. Phone Number*
6. Email*
8. Address1*
10. City*
11. State*
12. Zip*
14. What are your preferred pronouns?*
    -- Select One --he/his she/herthey/their ze/zirPrefer Not to Answer
15. Please Provide your age range as of July 1, 2021 *
    -- Select One --18-22 years old23-28 years old29-35 years old36-40 years old40 and older
16. Please indicate your Race *
    -- Select One --American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhitePrefer Not to Answer
18. Are you committed to a MYPC meeting once a month? *
    -- Select One --YesNo
19. Are you willing to serve a two year term? *
    -- Select One --YesNo
21. How did you hear about the Mayor’s Young Professional Council? *
23. What company do you work for? If you are an entrepreneur, indicate your firm and industry.*
24. What is your title or current position? *
26. How long have you been with your current employer? *
    -- Select One --Less than a year1 to 2 years3 to 5 years5 years or more
27. How long have you lived in Shelby County?*
    -- Select One --Less than a year1 to 2 years3 to 5 years5 to 10 years10 to 20 years20 +years
29. If you have lived in Shelby County less than 5 years, would you share what brought you Shelby County? *
31. List your 5 favorite things about Shelby County. *
33. What professional and/or civic organizations are you associated with, if any?
35. What would you like to contribute in service to the Mayor's Young Professional Council*
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field