Thank you Dr. Brenda Nelson-Porter for referring me to the following associations: (select one)

Purchasing              Technology                   Finance
Women Issues         Mentoring                        Construction
Nursing                   Management                    Writing/Editing
Diversity                 Executive Leadership   Fashion 
Small Business       Psychology                 Sociology
Medical Doctor      Dentist                       Teacher
Physical/Massage Therapist          Other:

Based on the selection of the Firm, I would like for the Firm to mail an information package to:
Name: 
Address: 
City, GA, Zip: 
Email: 
Phone: 
Occupation: 

Why Not Currently Networking (Personal information will not be considered; however, this brief statement may be used for/as statistical and textual data that may be published by the Firm or the University):


Membership:
    Student        Regular

I am interested in receiving information on scholarships: no  yes

Why I am interested in serving on a committee:

Optional Information:    Race:      Gender:      Age:

Disclaimer: Pressing the Submit Button indicates that the potential member is electronically signing the document and would like to receive the selected information from a professional association and not to be added to any association’s email list at this time. Brigette's will not be held liable for what an Association might do with the information provided.