Attendee Registration Form

We are excited meet you at the Career Summit! Fill out the information below to confirm your registration.

Name Name First Last
Email Address
City
Zip Code
Please select the city of the career summit that you'd like to attend.

Please select the city of the career summit that you'd like to attend. 1/28 - Harlem: Adam Clayton Powell Jr State Office Building - Art Gallery 2nd Floor 2/18 - Syracuse: 219 Walton St, Syracuse, NY 13202
Are you actively seeking employment in the cannabis industry?

Are you actively seeking employment in the cannabis industry? Yes No
Desired Job Title
Number of year's of experience

Please include any underground years of experience
Do you consider yourself legacy? (Someone having gained knowledge & experience of cannabis under it's prohibition in New York State?)

Do you consider yourself legacy? (Someone having gained knowledge & experience of cannabis under it's prohibition in New York State?) Yes No
Would you like more information on cannabis jobs in your area?

Would you like more information on cannabis jobs in your area? Yes No
Would you like a free membership created on NYSCannabisConnect.com in order to keep up with the latest cannabis news, events and information for cannabis in New York?

Would you like a free membership created on NYSCannabisConnect.com in order to keep up with the latest cannabis news, events and information for cannabis in New York? Yes No
Age

Age 18-24 25-34 35-44 45-54 55-64 65+
Race/Ethnicity

Race/Ethnicity Black or African American American Indian or Alaskan Native Asian White Native Hawiian or Other Pacific Islander From multiple races Other
How did you hear about us?

How did you hear about us? Instagram NYSCannabisConnect.com Facebook Other Other
Terms & Conditions Agreement

Terms & Conditions Agreement By submitting this form, I acknowledge that I have read, understand, and agree to our Terms & Conditions and Privacy Policy.