Apply to “Get on Board” Program – Board Candidates

Get on Board: Break into the Boardroom Candidate Application

BiB Candidates

First Name *

Last Name *

Current Company *

Current Job Title *

Email Address to Contact You *

Phone Number *

Mailing Address *

# Employees of Current Company *

Revenue Range of Current Company *

Company Stage *

Company Sector *

Headquarters of Current Company *

City, State, Country

Assistant's Email Address

Prior Company *

Prior Title *

Please list any relevant experience, including past or current board positions (non-profit, public or private):

Please attach a resume or, if unavailable, professional bio: *

Drop a file here or click to upload Choose File

Maximum upload size: 10.49MB

LinkedIn Page Link: *

I approve to have my background information shared with interested organizations *

Yes

Time stamp