Board Member Information Form
Personal Information
Name
*
Last Name
First Name
Formal Title (e.g., Dr/Mr/Miss/Mrs/Mx)
Preferred Email for Board Correspondence
Personal Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Alternate Phone Number
-
Demographic Information
This section is OPTIONAL. Please keep in mind that many funders request information regarding our Board Members' personal information to assess our Board diversity and the representation of communities we serve!
Date of Birth (Month/Day/Year)
Gender Identity
Ethnicity
Business/Work Information
Title/Profession
Company/Organization
Email (if different)
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Work Phone
-
Extension
Bragging Links: Please insert links to your Linked In or any resources you want to share that highlight your work
Headshot (Upload Here)
Browse Files
Cancel
of
Upload Bio (or insert LinkedIn link to your bio above)
Browse Files
Cancel
of
Submit
Thank you for your service to Building Young Moguls!
Should be Empty: