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First Name
Last Name
Email Address
Company
Job Title
Mobile Phone
Zip Code
Are you/your organization a U.S. Chamber member?
Yes
No
Unsure
How would you best categorize your organization?
Academia
Chamber/Association
Consultant
Corporation
Government
Non-profit
Media
Small business
Think tank
How would you best describe your role?
President/CEO
C-Suite
Vice President
Director
Manager
Other
Approximately how many U.S. Chamber events have you joined in the past?
1-2
3-5
6+
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