Exchange Membership Details

About You
Tell us about yourself. Your biography and headshot will be used as part of a members pack which will be sent to your fellow Board Members.

First Name

Last Name

Contact Number

Bio

Please provide a short biography about yourself (300 words)

Please select the skills you have proficiency in:

Board Director Experience

Strategic Planning

Risk/Opportunity Management

Corporate Governance

Environmental, Social and Corporate Governance

Board Development/Succession

Merges/Aquisitions

Preparing for Exit

Marketing

International Business - Americas

International Business - Asia Pacific

International Business - Europe

International Business - Middle East

Please choose the topics which most interest you:

Growth Strategies

Work-life Balance and Personal Growth

Merger and Aquisitions

Company Culture and Values

International Growth

Innovation and Disruption

Raising Capital

Exit Strategy

Medical Information
This information is confidential and will not be kept beyond the duration of your membership. The information will be seen only by Lisa Ferguson or her deputy will be provided only to emergency services/first responders should the need arise.

Please provide the Name, Address and Phone Number of your General Practitioner

Do you have any known allergies or medical conditions we should be aware of? If so, please provide details below:

Do you carry any emergency medication? (e.g. Asthma Inhaler, GTN Spray, Epipen etc) If so, please provide details below, including where you carry this on your person:

Do you have any dietary requirements?

No dietary requirements Vegetarian Vegan Pescatarian Gluten-free Dairy-free Halal Kosher Other

Please provide any further details:

Exchange Membership Details

Please fill in the form below.

About You

Medical Information

Emergency Contact Details:

Emergency Contact 1

Emergency Contact 2