Name* First Last Title* Jurisdiction* Jurisdiction Population*Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Point of Contact Phone*Point of Contact Email* # of years with this jurisdiction*Any previous jurisdictions? Yes No If Yes, Where? When? Member of TAMIO* Yes No If Yes, how long? Describe your job duties:Would you like to be a...?* Mentor Mentee When being paired with a mentor/mentee, what is your preference for your partnership?* Small-city communicator partnered with a fellow small-city communicator Small-city communicator partnered with a larger city communicator Larger-city communicator partnered with a small-city communicator Larger-city communicator partnered with a small-city communicator No preference For mentor candidates only – strengths (mark all that apply): Select All External communications Internal communications Crisis communications Strategic communications Website Development Social Media Strategy Special Event Marketing Video Production Citizen publications/newsletters Volunteer programs For mentee candidates only - areas where you would like professional growth (mark all that apply): Select All External communications Internal communications Crisis communications Strategic communications Website Development Social Media Strategy Special Event Marketing Video Production Citizen publications/newsletters Volunteer programs
