New CEO Profile Form

Please complete the fields below with the requested answers. All information is kept strictly confidential.

Please send the member’s current bio (.pdf), headshot (.jpg or .jpeg) and company logo (.png or .eps) to Jackie Pervan at jcp@columbuspartnership.com.

Preferred file formats for each listed in parentheses above.

Legal Name

Please include middle initial with first name.

First Name

Last Name

Middle Initial

Preferred (or informal) first name

By what name does the executive prefer to go by? (I.e. Mike versus Michael)

Salutation

Pronouns

He/Him/His

She/Her/Hers

Ze/Hir/Hirs

They/Them/Theirs

No Pronoun

No Preference

Not Listed

Role/Title

Company/Organization Name

(Legal/formal company name preferred for listing in our materials.)

Company/Organization Mailing Address

Where can we send mail to the member's attention? Please include any necessary suite, office, floor or P.O. numbers.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone (Office)

(###)

###

####

Assistant's Name

First Name

Last Name

Assistant's Email

Assistant's Phone

(###)

###

####

Board Affiliations

Please list any boards or professional councils that the member currently sits on.

Regional FTEs

Please list how many full time employees currently work in the Columbus Region (across all local facilities).

Is the company on the Fortune 1,000 list?

If so, please list the ranking below.

Member Personal Info

All personal information is kept strictly confidential.

Mobile Phone

(###)

###

####

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Spouse/Partner Name

First Name

Last Name

Dietary Preferences

Please list any preferences we should be aware of (i.e. does not drink alcohol, loves diet coke, prefers red wine over white, does not eat pork, etc.)

Please list any dietary restrictions for the member and/or spouse.

Have you (the CEO) ever served in the U.S. Armed Forces, military Reserves, or National Guard?

If yes, please clarify branch and any special rankings below.

Yes

T-shirt size

Select one

Date of Birth

YYYY

Comments/Notes

Anything else about the member we should know?

Executive Leadership Team

Our organization often works closely with senior executives within our member companies in the diversity equity & inclusion, human resources, marketing, and government affairs capacities. If you have folks in these roles in your organization, please complete the additional fields below with their information.

DEI Officer Name

First Name

Last Name

DEI Officer Title

DEI Officer Email

Government/External Affairs Officer Name

First Name

Last Name

Government/External Affairs Title

Government/External Officer Email

HR Officer Name

First Name

Last Name

HR Officer Title

HR Officer Email

Marketing/Communications Officer Name

First Name

Last Name

Marketing/Communications Officer Title

Marketing/Communications Officer Email

Do you have space at your office/facilities that you would be willing to host a Partnership meeting or event?

If you answered yes to the previous question, please list space capacity.