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Member Registration To join Association Leadership, please take a few moments to complete the registration form. This information is used to tailor the content and communications of Association Leadership. (Your information is kept completely confidential. Read our privacy policy.) Salutation (required) Mr. Mrs. Ms. Dr. Rev. First Name * (required) Last Name * (required) Association or Business Name * (required) Street Address (required) Apartment/Suite City (required) State (required) Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other Postal Code (required) Country (required) United States of America Canada Other Other Country Daytime Phone (required) Fax Email (required) This email is in use, please try another. Confirm Email (required) Secondary Email Confirm Secondary Email What is your role/involvement with the association community? (required) Association or Non-Profit Staff Member Association or Non-Profit Board Member Volunteer Committee Member Other Volunteer Leader Vendor/Supplier Consultant/Service Provider Other role/involvement What are your primary job responsibilities? (Check all that apply.) (required) Administration Advertising Attorney/Legal Affairs Chapter/Component Relations Communications Computer/MIS Consumer Affairs Controller/CFO Customer Service Education/Certification Executive Management For-Profit Subsidiary Fundraising Government Relations/Lobbying Human Resources Information Services/Library Insurance International Relations Legislative Analyst Marketing Meetings/Trade Show Membership Office Management Personnel Public Relations/Marketing Publications Editor Publishing Research Research/Statistics Sales Strategic Planning Technical/Industry-Specific Volunteer Leader Other Job Responsibility Please select a username and password of four to twelve characters or letters: User Name * (required) This name is in use, please try another. Password * (required) Confirm Password * (required) What industry or field best describes the association for which you work or volunteer? (Check all that apply.) (required) Healthcare Education Human Services Government Financial/Real Estate/Insurance Manufacturing Commercial Environment/Agriculture/Science Agriculture/Science Information/Technology Engineering Construction Management/Marketing Philanthropic Other Industry or Field How would you describe your organization? (required) Trade Association Individual Society Philanthropic Charitable Foundation Association related foundation Cause related organization Union Fraternity/Sorority/Club Other organization What is your level of responsibility? (required) Volunteer Committee/workgroup leader Senior Staff responsible for multiple staff/multiple project Volunteer Officer or member of board of directors Chief Volunteer Officer Deputy Chief Staff Executive Chief Staff Executive Other responsibility What is your organization's tax status? (required) 501(c)(3) 501(c)(6) For profit Other (including government) Don't know What type of members does your organization have? (required) Company/Trade Individual Company & Individual Other Other What is the geographic scope of your organization? (required) International National Regional State Local What is the total staff size of the association you represent? (required) 1 - 9 10 - 19 20 - 49 50 - 99 100 - 149 150 - 299 300 - 499 500 - 999 1,000 or more From what areas does your organization derive revenue? (required) Contributions Dues Education For-Profit Enterprise Grants Investments Publications Trade Shows Unrelated business income Other What is the annual budget of the association you represent? (required) $100,000 or less $100,001 - $500,000 $501,001 - $1,000,000 $1,000,001 - $2,500,000 $2,500,001 - $5,000,000 $5,000,001 - $10,000,000 $10,000,001 - $50,000,000 $50,000,001 - $1,000,000,000 $1,000,000,001 or more In what year were you born? (required) 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 Gender Male Female Which of the following applies to you and your organization? (required) I have worked with Tecker Consultants at this organization. I have worked with Tecker Consultants at another organization. I have attended one CEO Symposium or another Tecker Consultants program. I have attended multiple CEO Symposia or other Tecker Consultants programs. Others in my association have previously worked with Tecker Consultants. Neither my association nor myself has previously worked with Tecker Consultants. Yes, please send me occasional invitations to participate in surveys by companies that serve the association industry. I understand my contact information will not be shared and my privacy is completely assured.

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