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* 1. Name of C-suite executive:

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* 2. Company:

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* 3. Title:

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* 4. Location (country or U.S. city and state):

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* 5. Email address:

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* 6. Alternative email address (for instance, PR contact):

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* 7. Phone number:

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* 8. Areas of special expertise or interest:

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* 9. If available, please upload a photo (simple head shot preferred):

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