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2012 CareerLider LIVE Attendee Registration Form

2012 CareerLider LIVE Banner


CHCI is excited to have you join this year's CareerLider LIVE.  Please complete the following information.  We look forward to connecting you with local and national employers on September 12.

Should you have any questions or concerns, please contact Estefanie Maldonado at emaldonado@chci.org.  



First Name * 
Last Name * 
Address * 
City * 
State (two-letter format) * 
Zip Code * 
Email * 
Field of Study (if in college) 
Company/Organization (if employed) 
Title (if employed) 
Occupation (if employed) 
Please indicate your Hispanic heritage. If you are not Latino, please enter your ethnicity or "N/A." * 
Age * 
 Under 18
 18 to 25
 26 to 30
 31 to 35
 36 to 45
 46 to 55
 56 to 65
 Over 65
Gender * 
 Male
 Female
Highest Level of Education Completed * 
 I am currently in High School
 High School Graduate
 I am currently in College
 Associate's Degree or Professional Certification
 College Degree
 Graduate Degree
 Doctorate Degree
Annual Salary 
 Less than $10,000
 $10,001 to $30,000
 $30,001 to $50,000
 $50,001 to $70,000
 $70,001 to $100,000
 More than $100,000
By registering for this event, I agree to be photographed or videotaped for possible use in CHCI publications and other printed or online marketing materials. Enter "YES" (case-sensitive) to agree.  * 
* Required


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