Full Name

Organization

Contact Email

Phone Number

LinkedIn Profile

Areas of Expertise (e.g., AI, Blockchain, Data Science, etc.)

Availability (e.g., hours per month or preferred engagement model)

Industries of Interest (e.g., Social Technologies, Cybersecurity, etc.)

Professional Background & Advisory Experience [Summarize your career highlights, previous advisory roles, and relevant experience (150–300 words)]

Additional Comments (Any other details you’d like to share)