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Individual Member Application Form

(For corporate membership applications email Jack Myers at jack@mediavillage.com)

Name*
First Last
Title*
Company*
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Email*
Phone*
Phone
Years Working in Media
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Industry Honors
Organization Memberships
Council Preferences
- AdvancingDiversity
- WomenAdvancing
- Legends & Leaders
- Jack Myers ThinkTank
- 1stFive
- The Future of Men
JMKE Individual Membership
Price: $1,750.00
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