Please complete the entire application before submitting it.

Our goal is to learn about you and your company in order to appropriately place you in a group of similarly qualified women. The application should take less than 20 minutes to complete, so please don't put off your submission until the last minute. We make admission decisions in the order of receipt and give preference to those applications submitted by April 10, 2012. Your information is confidential and will not be shared. Please be assured that RISE appreciates diversity and does not discriminate based on race, age, religion, ability, marital status, or sexual orientation. We are, however, a group designed specifically to meet the needs of women leaders. To submit your application, simply hit the SUBMIT button at the end of this online form. The application may also be printed, completed, and mailed to: RISE Leadership Forum, 1201 Ninth St., Monterey, CA 94940.

General Information
First Name Last Name Prefix Ms. Mrs. Miss Dr. Other Preferred Nickname/Familiar Name (Optional) Date of Birth (Month/Day/Year) Home Street Address, City, Zip Code, Apt or Unit #

Home Telephone (If Applicable) Mobile Telephone (If Applicable) Work Phone Number (Direct Dial or Main Number and Extension #)

Preferred Telephone Numbers

Home Telephone Mobile Telephone Work Telephone No Preference

Personal E-Mail Address Work E-Mail Address Preferred E-Mail for RISE Personal E-Mail Work E-Mail

About Your Company or Organization

Company or Organization Name Division (If Applicable) Street Address, City, Zip Code, Mail Stop/Floor/Suite #

Main Phone Number Website Products and Services Annual Gross Sales Number of Employees

About You
Title To whom do you report? (Name and Title) How many reporting levels are above you? How many employees work for you, including all levels below you? How many employees report to you directly?

Indicate Your Current Industry (Check Only One) Manufacturing:

Aerospace/Automotive/Transportation Equipment Agriculture, Food, and Beverage Biotechnology Chemicals Consumer Products Energy/Extractive Minerals Heavy Capital Intensive/Raw Materials Suppliers High Technology/Electronics Highly Diversified Manufacturing/Non-Manufacturing Machinery and Equipment Manufacturers Medical/Healthcare Devices Paper and Forest Products Pharmaceuticals Software Textiles Other

Non-Manufacturing

Accounting Advertising Advocacy/Legal Services Broadcasting Commercial Banking Computer-Related Services Construction Consulting Education Engineering Entertainment/Leisure Environmental Conservation Food Service/Lodging Foundation/Grantmaking General Government Health Services Housing and Urban Development Insurance and Diversified Financials Investment Banking/Brokerage Investment Management Military Printing/Publishing Real Estate Retailing/Wholesaling Social Services Telecommunications Trading Transportation Utilities Other Non-Profit Other

What is your professional role? (Check All That Apply)

Founder Owner Chief Executive Officer President General Manager C-Level (Non-CEO) Executive Vice President Director Manager Other

What best describes your function? (Check One Only)

Accounting/Control Engineering Finance Fundraising General Management/ Leadership Human Resources Information Services/ Information Technology Law Logistics Manufacturing/Operations Marketing Medicine Planning Product Development Project Management Public Relations Purchasing Religion Research and Development Sales Teaching Other

Annual Salary

Other Annual Compensation (Bonus, Commission, Stock Grants, Stock Options or Other; Indicate Type)

Experience
Total Number of Years of Professional Experience Please List At Least Three of Your Most Significant Jobs in Reverse Chronological Order Beginning with Your Most Recent Employer (Indicate Company, Your Title, From/To Dates) Please List Any Volunteer Experience That You Think is Relevant to Your Career (Optional) Please Summarize Your Career Path in 1-3 Paragraphs

Education
Educational Programs (Check All That Apply) Completed High School AA (Two-Year College) Some College BA/BS MA/MS/MBA JD/Law MD PhD List Degrees or Certification Indicating Award, Dates of Study, Name of Program, and Institution/University List Other Education, Certification, or Training That is Relevant to Your Career Indicating Award, Dates of Study, Name of Program, and Program Provider