Username

Email

First Name

Last Name

Password

Password Again

Race Black or African American Hispanic or Latinx Asian or Pacific Islander Native American or Indigenous White Other

Gender Male Female Non-binary I prefer not to say Other

Age

Birthdate (MM-DD-YYYY)

Undergraduate Institution

Undergraduate Degree

Graduate Institution(s)

Graduate Degree(s)

Employer

Work Experience Executive Level Senior Level Manager with 1+ direct reports Mid-Level Intermediate Level Entry Level

How many years of work experience do you have?

If you're an engineer, what kind are you?

Are you a National Member? Yes No

Phone Number

Geographic Location Boston Greater Boston Area Outside of Boston, but in MA Non-MA Resident

Are you a recent grad? If so, please send an email to membership@nsbeboston.org Yes No

Select Option 1 Option 2 Option 3

Date Field