Personal Contact Information

First Name (required)

Last Name (required)

Preferred Email - Personal Preferred (required)

Your Best Contact # - Mobile Preferred (required)

Home Zipcode

Company/Work Information

Company Name

Title

LinkedIN Profile Link:

Work or Personal Website URL:

Work Phone

Work Email

Work Zipcode

Expertise & Interest Areas

What areas are you willing to volunteer for?
(Check all that apply - required)
General FlyTallLevel Up Your FutureTechSavvyNCWITOther (Please Specify in additional info area below)

What areas are you areas of expertise?
(Check all that apply - required)
Software DevelopmentC-Level IT MgmtWeb/EcommerceConsulting/Strategy ProjectsTelephony/VOIPDatabase & CloudCybersecurity/Digital TransformationEducation/MentoringOther (Please Specify in additional info area below)

Are you interested in the possibility of Board Membership in the future?
YesNoMaybe
**NOTE: Board membership is an invitation-only opportunity and is extended privately with additional details of what responsibilities are included with this role.

Additional Comments and Details:

Which is bigger, 3 or 9?