Name
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First Name
Last Name
Email
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Phone
(###)
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####
Address
We send annual/bi-annual mailings from Impact, which is the reason we ask for your mailing address.
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
What is your connection to Impact Retreat?
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Current Occupation Field
Healthcare Practitioners and Technical Occupations:
- Chiropractor
- Dentist
- Dietitian or Nutritionist
- Optometrist
- Pharmacist
- Physician
- Physician Assistant
- Podiatrist
- Registered Nurse
- Therapist
- Veterinarian
- Health Technologist or Technician
- Other Healthcare Practitioners and Technical Occupation
Healthcare Support Occupations:
- Nursing, Psychiatric, or Home Health Aide
- Occupational and Physical Therapist Assistant or Aide
- Other Healthcare Support Occupation
Business, Executive, Management, and Financial Occupations:
- Chief Executive
- General and Operations Manager
- Advertising, Marketing, Promotions, Public Relations, and Sales Manager
- Operations Specialties Manager (e.g., IT or HR Manager)
- Construction Manager
- Engineering Manager
- Accountant, Auditor
- Business Operations or Financial Specialist
- Business Owner
- Other Business, Executive, Management, Financial Occupation
Architecture and Engineering Occupations:
- Architect, Surveyor, or Cartographer
- Engineer
- Other Architecture and Engineering Occupation
Education, Training, and Library Occupations:
- Postsecondary Teacher (e.g., College Professor)
- Primary, Secondary, or Special Education School Teacher
- Other Teacher or Instructor
- Other Education, Training, and Library Occupation
Other Professional Occupations:
- Arts, Design, Entertainment, Sports, and Media Occupations
- Computer Specialist, Mathematical Science
- Counselor, Social Worker, or Other Community and Social Service Specialist
- Lawyer, Judge
- Life Scientist (e.g., Animal, Food, Soil, or Biological Scientist, Zoologist)
- Physical Scientist (e.g., Astronomer, Physicist, Chemist, Hydrologist)
- Religious Worker (e.g., Clergy, Director of Religious Activities or Education)
- Social Scientist and Related Worker
- Other Professional Occupation
Office and Administrative Support Occupations:
- Supervisor of Administrative Support Workers
- Financial Clerk
- Secretary or Administrative Assistant
- Material Recording, Scheduling, and Dispatching Worker
- Other Office and Administrative Support Occupation
Services Occupations:
- Protective Service (e.g., Fire Fighting, Police Officer, Correctional Officer)
- Chef or Head Cook
- Cook or Food Preparation Worker
- Food and Beverage Serving Worker (e.g., Bartender, Waiter, Waitress)
- Building and Grounds Cleaning and Maintenance
- Personal Care and Service (e.g., Hairdresser, Flight Attendant, Concierge)
- Sales Supervisor, Retail Sales
- Retail Sales Worker
- Insurance Sales Agent
- Sales Representative
- Real Estate Sales Agent
- Other Services Occupation
Agriculture, Maintenance, Repair, and Skilled Crafts Occupations:
- Construction and Extraction (e.g., Construction Laborer, Electrician)
- Farming, Fishing, and Forestry
- Installation, Maintenance, and Repair
- Production Occupations
- Other Agriculture, Maintenance, Repair, and Skilled Crafts Occupation
Transportation Occupations:
- Aircraft Pilot or Flight Engineer
- Motor Vehicle Operator (e.g., Ambulance, Bus, Taxi, or Truck Driver)
- Other Transportation Occupation
Other Occupations:
- Military
- Homemaker
- Other Occupation
- Don't Know
- Not Applicable
Additional Comments
Please feel free to share any additional information you would like.
