First Name

Last Name

Email (personal email recommended)

Phone number

Current Job Title

Current Employer

Please provider your LinkedIn profile URL

Please indicate the total headcount of your organization Please indicate the total headcount of your organization1-4950-99100-499500-10001000+

How many years of industry-specific experience do you have? How many years of industry-specific experience do you have?0-55-1010-1515-2020+

Select up to 3 responses that best describe your current professional goals Select up to 3 responses that best describe your current professional goals I want to learn about new carreer opportunities I want a promotion in the next 12 months I want to start my own company one day I want to be a mentor to an up-and-comer I want to bolster my personal brand through my Procurement Circle membership by taking an active role in the community- host events, drive topical discussions, and/or join my chapter steering committee I want to help my company through a successful liquidity event I want to support my company break through the next level I want to keep my finger on the pulse of the industries that matter to me I want to amplify the impact I have at work I want to be considered a trusted resource in my discipline

Brief Bio (2-3 lines to include # of years commercial experience, any vertical specialism, particular expertise, or anything else you feel is particularly pertinent)*