ApplyPlease answer all questions. Only completed forms will be processed. * I certify that all the information and accompanying materials provided in connection with this application are authentic and accurate. Salutation * Mr. Mrs. Ms. Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Mobile Phone * (###) ### #### Title or Position * Company/Organization Name * Company/Organization website * http:// Referred By * Are you currently on a corporate board? * Yes No If yes, what is the name of the company? Website of the company? http:// Is this a public company? Yes No How many years have you been on the board? What function best describes your area of focus? * Accounting/Control Energy Engineering Finance Fundraising General Management Human Resources Information Services Law Logistics Manufacturing/Operations Marketing Medicine Mining Planning Product Development Project Management Public Relations Purchasing Religion Research & Development Sales Teaching Other If other, please specify. Your current industry * Agriculture Apparel Banking Biotechnology Chemicals Communications Construction Consulting Consumer Products Education Electronics Energy Engineering Entertainment Environmental Finance Food & Beverage Government Health Care Hospitality Insurance Machinery Manufacturing Media Mining Not For Profit Oil & Gas Pharmaceuticals Professional Services Raw Materials Real Estate Recreation Resources Retail Shipping Technology Telecommunications Utilities Other If other, please specify. Are you interested in taking one of our board certification programs? * Yes No If so, which one? Live Board Certification Online Board Certification If you are a current director, are you interested in taking the CDI Certification Exam? If yes, you will be notified when this offering becomes available. Yes No Have you attended other board training programs? * Yes No If yes, what was the program name and date? Tell us why you want to be or like being on boards? * Thank you for your applicaton! We will get back to you within the next week.
