Blue Scarf Society Questionnaire

Name *

First Name

Last Name

Mobile phone

(###)

###

####

Date of birth

MM

DD

YYYY

Do you plan to participate as a mentor or mentee?

Mentor

Mentee

Blue Scarf Society membership includes enrollment in our Women's Leadership Academy. This is a 2-part workshop with varying dates/times. You may sign up now as follows:

I will attend Part 1 on Sat. Sept. 17, 2022.

I will attend Part 2 on Sat. Oct. 22, 2022. (Part 1 is a prerequisite for Part 2.)

I will attend Part 1 on Fri. March 20, 2023.

I will attend Part 2 on Fri. April 14, 2023. (Part 1 is a prerequisite for Part 2.)

All members receive a blue scarf to be worn with pride. Have you received your scarf?

Yes, I have received my scarf.

No, please present me with a blue scarf at our next event.

If you would like to participate in our Blue Scarf Society committee, helping to plan and execute future programming, please let us know below.

Yes, I am interested in joining this committee. Please contact me with more information.

No thanks, I wish to be a member but I don't have the capacity to serve on a committee.