Name of Country - e.g., United States

Name of State/Province/Region, etc. - e.g., California. 

Name of City - e.g., San Jose

Name - e.g., Carla Hayden (born August 10, 1952)

select from the options: Male or Female or Other or "I prefer not to say"

you may give either your personal email or official email or both, but personal email is preferable

e.g., Librarian, Student, Professor, Library Science Blogger, Library Services Vendor, Library Supplier, etc.

Name of the Institution, Organization, etc. where you work - e.g., San Jose State University or Librarianship Studies & Information Technology blog. 

Name of the Library, etc. where you work - e.g., Dr. Martin Luther King, Jr. Library.

Name of the Department, School, etc. where you work - e.g., Cataloging Division, or, School of Information Sciences.

Please provide your Name of Degree in Library and Information Science, Name of University, Institute, etc., followed by the Name of Country and year of completion. See the below example:
Master of Library and Information Science (MLIS) from San Jose State University, School of Information Sciences, United States in 2002.
Doctor of Philosophy (Ph. D.) from University of Illinois Urbana-Champaign, School of Information Sciences, United States in 2012.
Certificate in Library Leadership from Library Juice Academy (online) in 2015.