Lex 2X Exec™ Membership Application

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* 1. Name

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* 2. Email:

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* 3. Country

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* 4. Which Membership Circle do you wish to join?

C- Suite Circle with 1 to 1 Executive Coaching

C-Suite Circle with Peer Advisory Small Group Executive Coaching

Themis Circle (A)

Themis Circle (B)

Themis Circle (B) with 1 to 1 Executive Coaching Add-on

Themis Circle (A) with 1 to 1 Executive Coaching Add-on

Other (please specify)

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* 5. Professional Experience & Level

C-Suite, Executive Director, Founder, Senior Government or Justice Official, Academic Leader

Deputy Executive, Vice President, Department Head

Mid-level professional 10 + years experience

Late-early career professional 6-9 years experience

Other. Please describe below.

Other (please specify)

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* 6. LinkedIn URL

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* 7. Professional Field

Law

Tech

Other. Please specify your field and sector.

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* 8. If you are applying for a C-Suite Circle Membership, please indicate: 1) the number of direct reports you manage and 2) the number of individuals on the overall team you manage.

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* 9. If you are applying for a C-Suite Circle Membership, please indicate whether your report to the CEO, or if not, the number of supervisors between you and the CEO/executive leader of your organization.

I report directly to the CEO/executive leader of the organization.

I do not report directly to the CEO. There are 1-2 supervisors between my position and the CEO/executive leader of the organization.

I do not report directly to the CEO. There are 3 or more supervisors between my position and the CEO/executive leader of the organization.

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* 10. If you are applying for Themis Circle Membership, please indicate whether your primary interest is in entrepreneurship.

Yes

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* 11. Are you a member of any other professional organizations? If yes, please indicate which ones (optional question).

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* 12. Please indicate your motivations for applying. Check all that apply.

To obtain executive coaching

To access mentoring

To access education & skills training

To explore or strengthen entrepreneurship

To access a community and/or network

To collaborate and work on initiatives related to legal transformation or women and law

To explore a career transition

Lex 2X Exec™ Membership Application

Question Title

* 1. Name

Question Title

* 2. Email:

Question Title

* 3. Country

Question Title

* 4. Which Membership Circle do you wish to join?

Question Title

* 5. Professional Experience & Level

Question Title

* 6. LinkedIn URL

Question Title

* 7. Professional Field

Question Title

* 8. If you are applying for a C-Suite Circle Membership, please indicate: 1) the number of direct reports you manage and 2) the number of individuals on the overall team you manage.

Question Title

* 9. If you are applying for a C-Suite Circle Membership, please indicate whether your report to the CEO, or if not, the number of supervisors between you and the CEO/executive leader of your organization.

Question Title

* 10. If you are applying for Themis Circle Membership, please indicate whether your primary interest is in entrepreneurship.

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* 11. Are you a member of any other professional organizations? If yes, please indicate which ones (optional question).

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* 12. Please indicate your motivations for applying. Check all that apply.

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* 13. Sign me up to receive news and information on upcoming events.