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Chapter Interest
Contact Information

First Name
Last Name


Address Line 1
Address Line 2
ZIP/Postal Code
This means you're okay with being the point-person for your local branch
A chapter needs 3 or more committed members to be recognized. If you don't have 2 other volunteers, your mission is to recruit them!
This means you're happy to show up but don't want to take the lead

What problems do you want to solve?

What do you want your role to be? What skills do you want to share?