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The Social Network

Where Chicago professionals get connected.

Application

Wednesday February 22, 2012
We do not send this information out; it is simply for internal use only.

*Name
*Address
*City Zip
*Email Cell Phone
*Daytime Phone Evening Phone
Age Date of Birth
Marital Status Never Married
Divorced
Separated
Widowed 		Highest Level
of Education
Children Have
Want
Open to His/Hers
Religion (if any)
Political Affiliation (if any)
What do you like to do in your spare time? Interests? Hobbies?

What three words would others use to describe you?

What do you consider your three major accomplishments in your life thus far?

What would you hope to accomplish with membership?

Do you belong to other networking groups? If yes, plese list:






311 West Superior Street Ste 500, Chicago, IL 60610 Phone 312-806.2009 Fax: 708-430-9450