Chapter Leader Application BACK TO BE A CHAPTER LEADER If you start this application and you do not have time to complete select: “Save and Continue Later” below by the Submit button. An email will be sent to you with a link to continue later. Name* First Last Date* Date Format: MM slash DD slash YYYY Cell Phone*Email* Enter Email Confirm Email Chapter Location: City and State*How does the mission of LCW resonate with you and how do you see yourself supporting this mission?*What motivated you to start an LCW chapter?*What positive contributions will you make to the LCW as a Chapter Leader?*How do you describe the role of women in the chiropractic profession?*How did you originally hear about LCW?*Are you a:*CASpouse/Partner of a DCStudent or Spouse/Partner of a StudentDCAdministratorEducatorIf you are a DC or a Student what Chiropractic college did you graduate or currently attending?I confirm I have read WHAT TO EXPECT AS A CHAPTER LEADER and will abide by all that is required of me as a LCW Chapter Leader.*YES, I ConfirmPaste your YouTube link to your video here.*Please upload your CV or Resume here.* Save and Continue Later Thank You!