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Futurexx Chats Interest Form - Professionals
Get in touch here to let us know how you would like to get involved in Futurexx Chats
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Email
*
Your email
Name (first and last name)
*
Your answer
Way in which you would like to be a part of our mission:
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Speaker
Project Collaborator with other Professionals
Project Leader with Younger Professionals
Mentor
Discussion Group Member
Conference Contributor and Attendee
Partnering Organization
Donor
Advisory Capacity
Other:
Required
Elaborate on the above if appropriate.
Your answer
Professional information (position, organization, field)
*
Your answer
Relevant personal information (e.g., other organizations involved with, prior experience with mentoring, if mom who can speak to work/ kids balance, etc.)
Your answer
Geographical Location (city, state/ province, country)
*
Your answer
Name of the person from whom you heard about this (if a friend of Futurexx Chats):
*
Your answer
Anything else?
Your answer
Send me a copy of my responses.
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