Contributing Executive Application

First Name *

Last Name *

Phone *

Email *

Email 2

Birth Date(mm/dd/yyyy)

// (mm/dd/yyyy)

Gender

Company Name *

Title *

Years of Experience: *

City *

State *

Please provide your LinkedIn profile url? (in the event you do not have a LinkedIn, please email your resume to info@okwit.org) *

What do you hope to gain from your involvement with OKWIT? *

Is there anything specific you hope to contribute to OKWIT (related to your personal experience, mentorship, etc.)? *

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