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Account Details

Profile Details

Type of NPCC Membership (required)

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Group Member - Business, Organization, or Institution's Name (required)

(Please enter "Individual Member" , if not a Group Member)

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Main Industry Category (required)

(This is either the Individual Member's future, current or past field of work or the Group Members current Industry - EXAMPLES- Medicine, Law, Construction, Engineering, Agriculture, Retail, Automotive, Accounting, Hospitality, etc.)

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Sub Industry Category (required)

(This is either the Individual Member's future, current or past specific field of work or the Group Members current specific type of business, organization, or institution - EXAMPLES- Brain Surgeon, Pediatric Nurse, Prosecutor, Corporate Attorney, Criminal Attorney, Pluming and Air Conditioning, Tile Work, Civic Engineering, Cotton Farmer, Dress Shop Owner, Transmission Shop, Payroll Service, Waiter, Hotel Manager, etc.)

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Title

(This is either the Individual Member's Title or the Group Member's Main Contact's Title)

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First Name (required)

(This is either the Individual Member's First Name or the Group Member's Main Contact's First Name)

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Middle Name or Initial

(This is either the Individual Member's Middle Name or Initial or the Group Member's Main Contact's Middle Name or Initial)

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Last Name (required)

(This is either the Individual Member's Last Name or the Group Member's Main Contact's Last Name)

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Suffix

(This is either the Suffix of the Individual Member's Name or of the Group Member's Main Contact Name)

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Birth Date

(This is either of the Individual Member or of the Main Contact of the Group Member)

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Physical Address (required)

(This is either the Physical Address or the Individual Member or of the Group Member)

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Mailing Address (if different than Physical Address)

(This is either the Mailing Address of the Individual Member or of the Group Member)

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Main Contact's Phone Number: (required)

The main phone number.

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Main Contact Email Address (required)

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Group Member's Fax Number (if applicable)

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Website or Blog

(This is either the Individual Member's Website or Blog or the Group Member's)

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Other Key Information

(Please feel free to let us know anything else about you or your Group Membership that you feel might be helpful)

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