Your Name
Your Birthdate
Your Marriage Date
The organisation you represent
Do you own the organisation? YesNo
Your designation
Any alternate email ID
What are the most memorable years of your career?
Which sectors do you have deep experiences in, and where your knowledge / relationships are current?
Which senior management functions do your feel confident about, and are interested in taking up roles in? Which of the following geographies are you deeply exposed to (e.g. living, working, doing business etc.)? (Please tick any number of boxes)
IndianChinaJapanRest of AsiaAustralia / New ZealandMiddle EastNorth AfricaRest of AfricaEastern EuropeWestern EuropeNorth AmericaSouth AmericaAll What are your professional qualifications? (Please tick any number of boxes)
Any comments on your educational background (50 words) Do you have any exposure to startups in any capacity (e.g. employee, service provider, coach, mentor, consultant, investor etc.)?
YesNo
Which of the following best describes your preferred format of association? (Please tick any one) Deep and hands-on role in a single businessAdvisory role for multiple businesses Any other comments on preferred format (upto 50 words) Where are you located?
Any locational preferences? (upto 50 words) Would you like to upload your CV / Profile in pdf format? YesNo
Which social media channels do you access (Please tick any number of boxes) FacebookInstagramPinterestLinkedInYouTubeOther-Please Specify
Any other comments? (upto 100 words)
