Jamie's List Membership Application
Email
*
1.
First Name
*
2.
Last Name
*
3.
Email Address
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4.
Mailing Address (If you'd like to receive Jamie's List member gifts)
5.
Mobile Phone (opt-in to be added to the members WhatsApp)
6.
Age
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18-29
30-45
46-64
65+
7.
Gender
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Male
Female
8.
Industry (select all that apply)
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Entertainment
Finance
Healthcare
Sports
Real Estate
Technology
Art
Law
Marketing & PR
Fashion & Beauty
Other
9.
Company Name
10.
Job Title
11.
Instagram Handle (put N/A if not applicable)
*
12.
LinkedIn Handle (put N/A is not applicable)
*
13.
Please list members you know, if any (put N/A is not applicable)
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14.
What do you hope to get out of your membership in the Jamie's List community?
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15.
Please share a favorite book, tv show, movie, podcast, or media source so we can get to know you better. Don’t overthink this!
*