Advisory Board Contact Information form

Prefix

First Name *

Last Name *

Previous or Maiden Name (if applicable)

Email Address *

Phone *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Current employer/company name:

Current Role or Title:

Degree(s) completed:

Degrees(s) awarded from:

Please select the Advisory Board on which you serve, or wish to serve: *

Advisory boards typically meet virtually or in person 2-3 times per calendar year for approximately 90 minutes each meeting. As your schedule allows, are you willing to serve on this advisory board for the duration of 2021? *YesNoOther (please specify)

If other, please specify:

By default, Avila University does not publicize the names or companies represented on our advisory boards to third parties. However, when appropriate, Avila may have interest in highlighting supporters and key partners of the University for marketing purposes. Can we contact you regarding our ideas to include you marketing plans?Yes, I am open to discussionNo, I prefer not to be included in marketing efforts

Who do you know who would be a valuable member of one of our advisory boards in the future?