Birthdate (Month & Day only):
If you are a Full time STUDENT, what school do you attend? What is your anticipated graduation date? :
Are you a former NSA-NT member, or a member of the Houston or Austin NSA chapters? If so, which one? :
Are you currently a Member of a Texas Alliance Chapter (Austin or Houston)?:
Who should we thank for referring you to NSA-NT?:
What Committee would you be interested in volunteering? Choose from any of these: Marketing | Membership | Programs | Technology | Zoom Producer | Meeting Greeter | Meeting Photographer | None at this time:
Do you have any designations from ATD or SHRM?:
Do you have any speaking designations from Toastmasters?:
Do you have any speaking, academic, professional and/or awarded designations, licenses or certifications? (Also include veteran and/or military rank here.) :
What types of speaking do you do the most in your business?:
What year did you start speaking or training for your business or another organization?:
What Generation do you identify with?:
Do you have a specific need for a disability accommodation? (e.g. closed captioning, service dog, seating accommodations, etc.) :
Do you have any life threatening (food or other) allergies NSA-NT needs to be aware of? YES/NO If YES- please let us know so we can plan accordingly::
Do you carry an epi-pen? If so where would it be located if needed?:
Do you have any other health issue(s) that may necessitate emergency treatment NSA-NT needs to be aware of? YES/NO If YES please share what information NSA-NT needs to know::
Emergency Contact Information (Name/Cell Phone): :