First Name
Last Name
Phone #
Email
Password
Title
Affiliate/Auxiliary Group
Track Please select Board Development CFO Roundtable Entrepreneurship Center Program Growth Opportunities Guild Housing Track WFDD USJP Young Professionals (YP) Health Equity
Role Please select CFO Emerging Leaders Guild Member Guild Executive Staff NUL Staff Speaker UL Affiliate Board UL Affiliate Staff UL Affiliate CEO Young Professionals Member Young Professionals President
Region Please select Eastern Western Southern Central
What Skill Sets Are You Most Interested in Developing During This Event? What Is Your Primary Goal for Attending the Whitney M. Young Event? Please select To gain new skills for professional development To network and build relationships To contribute my experience to group discussions To explore leadership opportunities within YP To learn about YP history
What Kind of Group Dynamic Do You Thrive In? Please select Collaborative, brainstorming sessions Focused, problem-solving discussions Strategic planning and goal-setting Hands-on, action-oriented activities
What Leadership Skills Are You Looking to Improve or Gain? Are You Comfortable Leading a Group Discussion or Breakout Activity if Needed? Please select Yes No Maybe
Do You Have a Specific Challenge or Issue You’d Like Help Addressing Through Peer Collaboration?
Number of years in The Movement
I hereby grant the National Urban League permission to use my likeness in a photograph in any and all of its publications, including website entries without payment or any other consideration.
I understand and agree that these materials will become the property of the National Urban League and will not be returned.
I hereby irrevocably authorize the National Urban League to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing the National Urban League’s programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph.
I hereby hold harmless and release and forever discharge the National Urban League from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.
I am 21 years of age and am competent to contract in my own name. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.
