Board Contact Form

Thank you for agreeing to serve on the CFR Board! We’re honored you’ve chosen to give your time and expertise in service to our organization. Please fill out the form below and let us know if you have any questions.

Name
What is your full name, as you would like it to appear on Board listings? (Board member names are listed as preferred; some formally, some informally).
First Last
Post Nominal Initials
PhD, MD, etc.
What is your primary professional affiliation?
What is your professional title?
What other organizations are you affiliated with?
If married, what is your partner's name?
What is your preferred email address?*
What is your preferred phone number?*
The preferred phone number is your
- Cell
- Home
- Work
Is there an alternate phone number you would like us to have?
The alternate phone number is your
- Cell
- Home
- Work
Bio
Please provide a short bio of your professional background (250 words or less).
CAPTCHA
Please upload your professional headshot here
Accepted file types: jpg, png, Max. file size: 50 MB.
Instagram
This field is for validation purposes and should be left unchanged.

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Board Contact Form