Collaboration Program Registration
Name: 
Credit Union (current or previous):  
Asset Size: 
Title (most recent): 
Phone:   
Email:  
City:  
State:  
Zip:   
Are you staff, director, or retired?
How long have you been in the industry? 
Are you new to your position?

How long have you been in your current position? 
Are you a Leadership Academy student?

Would you be willing to be a mentor to a Leadership Academy student?

Please select desired role:

Note: If you would like to be both a mentor and a mentee, please submit this registration form for each role.
Mentors: Please check areas in which you are willing to provide guidance.

Mentees: Please check areas in which you would like to receive guidance.
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