Latino Corporate Directors Association

Current Title *

Current Company *

Do You Self-Identify as a U.S. Hispanic/Latino? If So, What is Your Hispanic/Latino Background? *

How Did You First Learn About LCDA?
Select all that apply

Internet Search (LCDA site, Google, etc.)

Conference

Which Conference?

LCDA Staff

Please Provide Full Name of Staff

Publication (Latino Leaders, Hispanic Executive, etc.)

Which Publication?

Social Media (LinkedIn, Twitter, Facebook, etc.)

Which Social Media Outlet?

Board Influencer (Search Firm, PE/VC, Nom/Gov Chair, etc.)

Please Provide Details

LCDA Member

Please Provide Full Name of the LCDA Member

Other

Please Provide Details

Are You a U.S. Permanent Resident or U.S. Citizen?

Yes

No

Which Category Best Describes Your Most Recent Role? *
Select all that apply

C-Suite Corporate Experience (Particularly CEO, CFO, CIO, CMO, CTO, COO, GC, and CPO positions)

EVP/SVP/VP, 1 to 2 levels removed from CEO in a Public Company or At a Private Company with Scale (Typically >$500M in Annual Revenues)

Entrepreneurs or Managing Partners/Directors of LLPs, LLCs or Mutual Companies with Annual Revenues of $20M or Higher

Former High Ranking Military Leaders and Formal National and/or Statewide Elected or Appointed Officials

Largest P&L or Budget Managed: *

Please Provide Your LinkedIn Profile or Link to Professional Bio: *

Current/Past Boards and Roles? Please Include Nonprofits Boards, Board Advisory Roles and Board of Trustee Positions *

(Word limit: 250)

Briefly Explain How You Have Supported The Advancement of the U.S. Latino Community By Paying It Forward *

(Word limit: 250)

Desired Timeline to Join a Board? *
Choose 1

Expected Retirement Timeline? *
Choose 1

LCDA Executive Membership Interest Form