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Candidate Profile Information
*
First
Middle
*
Last
*
Resume, Bio or CV
*
Photo / Headshot
*
Title
*
Organization
*
Occupational Area
Choose from the following industry / industry segment
--Please select--
Arts & Entertainment:Broadcast/News/Media
Arts & Entertainment:Museums/Galleries/Performing Arts/Attractions
Arts & Entertainment:Sports
Construction:Buildings, Infrastructure
Corporate:Board/Director
Corporate:Large-over 500 employees
Corporate:Mid-sized - under 500 employees
Education
Energy and Utilities
Engineering and Sustainability
Finance:Lending & Financial Services
Finance:Private Equity/Venture Capital/Investment Banking
Finance:Wealth Management covers ALL wealth, including Family Office)
Government/Public Sector:Ambassador, Diplomat/Governmental Representative
Government/Public Sector:Appointed/Elected Official
Health Care, Medicine, Health Sciences:Hospital
Health Care, Medicine, Health Sciences:Pharmaceutical/Research/Biotech/Medical Device
Health Care, Medicine, Health Sciences:Technology
Hospitality & Retail:Hotel & Restaurant
Hospitality & Retail:Merchandise
Law
Manufacturing
Non-profit:Foundations
Non-profit:Membership/Trade Organization/Association
Non-profit:Social Services
Non-profit:Other
Professional Services:Architecture/Design/Landscaping/Graphic Design
Professional Services:Human Resources/Staffing/Recruiting
Professional Services:Management Consulting
Professional Services:Marketing/Advertising
Professional Services:Public Relations
Professional Services:Sales
Professional Services:Training
Public Accounting & Financial Consulting
Real Estate:Brokerage, Consulting, Development, Property Management
Technology
Transitional / Retirement
Transportation, Distribution, Logistics
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Number of years at your current position or company?
*
Number of employees worldwide
--Please select--
Under 50
Under 100
Under 1,000
Greater than 1,000
Not Applicable
*
Operations outside the U.S. or Global Footprint?
--Please select--
Yes
No
Not Applicable
Annual Revenue
Business Website Address
*
Business Address
Business Address Line 2
*
City
*
State
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
*
Zip
Country
*
Business Phone
*
Email
Cell Phone
Admin Assistant
Admin Phone
Admin Email
*
Do you hold any current board positions?
--Please select--
No board positions currently held
NFP
Private
Public
NFP and Private
NFP and Public
Private and Public
Are you an Entrepreneur, Founder or Start Up?
--Please select--
Entrepreneur
Founder
Start Up
No - I am not
*
Are you a C200 Member?
--Please select--
Yes
No
*
Are you an Economic Club Member?
--Please select--
Yes
No
*
Are you an Executives' Club Member?
--Please select--
Yes
No
*
Are you a TCN Member?
--Please select--
Yes
No
*
Are you an Expatriate?
--Please select--
Yes
No
*
What is your Ethnicity?
Will not be published and/or shared
--Please select--
White
Hispanic or Latina
African American
Native American or American Indian
Asian / Pacific Islander
Other
Middle Eastern
*
Country of Origin
Country (if other than US) where you've had long-term residency?
*
Birthday
Will not be published and/or shared
*
Home Address
*
Home City
*
Home State
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
*
Home Zip
Home Phone
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