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JanFebMarAprMayJunJulAugSepOctNovDec Email Address Telephone Number Whatsapp Number Current Occupation / Job Title Number of Direct Reports Total Years of Work Experience (Years of Executive/Senior Leadership Experience) 0-5 Years 6-10 Years 11-15 Years 16+ Years Current Company Name Industry / Sector Banking / Finance Health Mining Manufacturing Retail Telecommunication Food Processing Education Tourism Textiles and Garments Transportation Oil and Gas Other If you chose "Other" in previous question, kindly indicate your industry Key Responsibilities Processing... Educational Background Highest Educational Qualification Field of Study Processing... Business Owner/ Entrepreneurs Business Name Type of Business Year Established Annual Turnover Number of Employees Skills and Competencies Processing... Board Memberships How many Board Membership are you in? (Corporate/NGO/Government) None 1 Board 2+ Boards Do you hold a C-Suite or equivalent leadership role? Yes No How many years have you been in that role? None 1-5 Years 6-10 Years 11 Years and above Tell about your role Processing... Estimated Professional Network Size Estimated Professional Network Size (Linkedin/Industry Connections) Less than 500 500 - 2,000 2,000+ Have you spoken at industry conferences or published thought leadership? Yes No Are you a member of other elite professional networks? (eg. Forbes Council, YPO etc) Processing... Joining EWN Reasons for joining EWN: (Briefly describe motivations and expectations) Mentorship Interests Yes No If Interested in our Mentorship program, indicate your preferred choice for sign-up Mentor Mentee Mentorship Goals Coaching Interests Yes No If Interested in our Coaching program, indicate your preferred choice for sign-up Coach Coachee Coaching Goals How did you hear about EWN? Inviting Member's Name Processing... Commitment to Ewn's Mission I will be available for an in -person orientation Yes No Kindly note that you are mandated to join our in-person Orientation. This is one of the first obligations as an EWN Member before you are added on our platform. How do you plan to contribute to EWN (Mentorship, Coaching, Speaking, etc) Are you willing to participate to at least 3 EWN events per year? Processing... References Reference (Kindly state names of two refecences- one must be an EWNer and the other a Professional reference Contact number/Email of both references References' Place of Work? Number of Years known? In what capacity do you know each other? Payment — Please note that the fee is not refundable Registration Fee: GHc100 1. Bank Transfer: Executive Women Network, Absa Bank (0301) 0000001001900 2. Mobile Money: 0558791324 (MTN), 0505110444 (TELECEL) Processing...
