Adviser Form

Join our Adviser and Specialist Group

Please tell us about yourself —

    Your first name*
    Your last name*
    Your email address*
    Your city*
    Your state or province
    Your country*
    Your LinkedIn profile*
    Your phone number*
    Your website
    Your education? Degrees earned and from where? Honors or special recognition? Other relevant coursework? *

    * Required

    What are your specific areas of expertise? (choose as many as you like)

    Is there anything in particular that you would like us to know? Any unique experience or accomplishments? Are you multilingual?

    Would you consider an "interim executive" or consulting role at a Tech-Rx portfolio company?*   Yes    No

    What would be your preferred role in such a company? (choose as many as you like)

    How should we display your profile on the Tech-Rx website?  Select      What does this mean?

    Describe yourself in 8 words or less. For example: "Engineering and Operations Leader" or "Mobile Game Development and Marketing" or "Medical Device Design and Manufacturing"

    Showcase yourself with a brief profile of about 100-150 words. Please do not restate your education.

    Upload your picture (head and shoulder shot, about 250x250 pixels, black & white preferred)

    You agree to our Adviser Terms and Conditions