Name
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First Name
Last Name
Email Address
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What is your leadership title?
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If other, please specify:
In what city/county and state do you hold this title?
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As a member or potential member of Western Leaders Network, what types of resources would be beneficial to you in your official capacity? (Check all that apply)
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If other, please specify:
What types of skill-building would benefit you as a leader? (Check all that apply)
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If other, please specify:
What issues are most pressing within the community you serve? (Check all that apply)
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Please provide details:
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What current, impending or ongoing issues at the state and federal levels most impact your community?
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What types of action might you be willing to take for Western Leaders Network initiatives? (Check all that apply)
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If other, please specify:
Would you be interested in attending an annual summit for Western Leaders Network?
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One of the goals of Western Leaders Network is to empower the next generation to seek leadership positions in their communities. As an experienced leader, what resources and materials would be helpful to a first-time campaigner?
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Would you like to be contacted by Western Leaders Network to stay informed on issues affecting western communities?
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How often would you like to receive news from Western Leaders Network?
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Do you know other local, western officials that might be interested in Western Leaders Network?
Additional comments or suggestions:
