First Name*
Last Name*
Email Address*
Address*
City*
State*
Zip*
Please help us make sure our agenda is relevant by sharing some information about yourself.
Feel free to answer only what you feel comfortable sharing.
What type of work did you do prior to your career break?
Accounting
Advertising/PR
Arts/Media/Entertainment
Consumer Products
Education/Training
Energy
Engineering/Architecture
Financial Services
Government/Military
Healthcare
Hospitality/Travel
Human Resources
Industrials
Insurance
Internet/New Media
Legal
Management Consulting
Manufacturing/Operations
Non-Profit/Social Enterprise
Other
Pharmaceutical/Biotech
Real Estate
Retail
Technology
Telecommunications
What was your job function?
Accounting/Control
Business Development
Consulting
Economic Analysis
Entrepreneur/Owner
Finance (Internal)
Financial Services
General Management
Human Resources
Information Systems
Law
Marketing
Operations/Production
Other Functions
Product Development
Real Estate
Regulatory Affairs
Research (Non-Financial)
Risk Management
Sales
Strategic Planning
Are you working now?
Full time
Part time
Not working
If you're not working, how long have you been out of the workforce?
When are you planning to go back?
Within a year
Within 6 months
Not sure
When you go back, will you be
Full time?
Part time?
Consulting?
Planning to start your own business?
Not sure
What degree/level of education?
Select one
Bachelor's
Master's
MBA
JD
Other
Have you thought of shifting careers?
Yes
No
Do you have an idea for a speaker or panel you feel would be of interest?
How did you hear about us?
Refer a Friend (Friend's Email)
1.
2.
Please give us an early indication of which breakout session you will choose:
Career Options Assessment Workshop
Network and Market Yourself Workshop
We are planning to distribute to all Career Relaunch attendees the names and e-mail addresses of all participants willing to share this information, so that you can keep in touch as you move forward with your career transition.
Please indicate if you are willing to have your name and e-mail address included in the conference attendee list distributed onsite to attendees.
Yes
No
* Indicates required field
Once you click Submit, you will be directed to a secure page to enter your payment information.
Note regarding photography and
videography: Representatives from The Career Relaunch Forum
may be taking photographs and taping portions of the program
for use in its own materials and in the media. By
registering for the Career Relaunch Forum, you are giving
permission to be photographed or videotaped during the
course of the program.
Cancellation Policy:
If you must cancel, we will refund your registration
fee, less a $25 processing charge, if the cancellation
is received by October 15. After that time, we are
unfortunately unable to refund your fee but will apply
it to a future Career Relaunch event.
Career Relaunch, LLC
462 South Parkway
Clifton, NJ 07014
973.458.1535