Glue Up account creation information.

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First Name *

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Last Name *

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e.g. john.doe@glueup.com

Email Address *

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・one upper case letter
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Password *

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・8 characters minimum
・one upper case letter
・one lower case letter
・one number
・one special character (@$!%*?&)

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Please enter a first name

First Name *

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Please enter a last name

Last Name *

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Please enter a valid email address
e.g. john.doe@glueup.com

Email *

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DEMOGRAPHICS

Gender *:

Test Group

Please select your gender * Female Male Prefer not to answer Other

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Specialty *

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Areas of sub-specialty interests / professional expertise: *

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City *

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State/Province *

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State/Province * Alabama American Samoa Alaska Arizona Arkansas Armed Forces Africa Armed Forces Canada Armed Forces Europe Armed Forces Americas Armed Forces Middle East Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Kansas Kentucky Louisiana Guam Hawaii Marshall Islands Illinois Indiana Idaho Iowa Massachusetts Maine Michigan Maryland Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virgin Islands Vermont Virginia Washington West Virginia Wisconsin Wyoming

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State/Province *

State/Province * Alberta British Columbia Manitoba New Brunswick Newfoundland & Labrador North West Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

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State/Province *

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Country *

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Do you self-identify as Black? *YesNo

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How do you identify? *:

Test Group

How do you identify? * African-Canadian African Afro-Caribbean African-Arab African-Indigenous Hispanic Mixed Race Other

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EVENTS

Would you be interested in participating in wellness events hosted by BPC? *YesNo

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Would you be interested in financial literacy training hosted by BPC? *YesNo

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NETWORK & COMMUNITY BUILDING

Would you attend an in-person national conference held by BPC within the next three years (as permitted by COVID-19 restrictions and public health guidelines)? *YesNo

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SUGGESTIONS

Do you have any comments, questions, or initiatives you would like BPC to address?

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