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BMBC Census
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Census Completion Entry
First Name
First Name is required.
Last Name
Last Name is required.
Mobile Phone Number
Mobile Phone Number is required.
Email Address
Email address is not valid
Date of Birth
Date of Birth is required.
Relationship Status
Married
Single
Divorced
Widowed
Relationship Status is required.
Address
AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Occupation
Occupation is required.
Occupation Category
Healthcare and Medical Services
Education and Teaching
Finance and Accounting
Legal and Law Enforcement
Information Technology (IT) and Software Development
Skilled Trades (Electricians; Plumbers; Mechanics; etc.) Sales and Marketing
Hospitality and Food Service
Arts; Entertainment; and Media
Government and Public Administration
Nonprofit and Community Services
Retail and Customer Service
Engineering and Architecture
Construction and Real Estate
Transportation and Logistics
Military and Defense
Science and Research
Entrepreneurship and Small Business Owners
Homemaker or Family Caregiver
Retired
Student (Full-Time/Part-Time)
Unemployed or Seeking Employment
Other
Occupation Category is required.
Do you have members 21 and under who live in your household?
No
Yes
Do you have members 21 and under who live in your household? is required.
Do you attend BMBC as an ONLINE ONLY member?
No
Yes
Do you attend BMBC as an ONLINE ONLY member? is required.
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