Participant Profile First Name (required) Last Name (required) Street Address (required) City (required) State (required) —Please choose an option—ALAKASAZARCACOCTDEDCFMFLGAGUHIIDILINIAKSKYLAMEMHMDMAMIMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPWPAPRRISCSDTNTXUTVTVIVAWAWVWIWY Zip Code (required) Phone Number (required) Email Address (required) Employer Title/Job Industry D.O.B. (mm-dd-yyyy) Interests: (Check all that apply) YouthFinanceCivil RightsSales/MarketingEvent PlanningCareer DevelopmentEducationCivic EngagementRace RelationsPublic RelationsSocial ServicesGovernmentHealthGrant WritingEconomic EmpowermentMentoringJournalismFund Raising Please attach a current resume Participant Contribution: $50.00 Make check payable to: Indianapolis Urban League 777 Indiana Avenue Indianapolis, IN 46202
