DEI Executive Exchange

Instructions

This form should be filled out by the person that will be participating in the program because there are questions about the candidate’s address, career background, etc.

If your employer is paying for your participation and you are unable to pay at the time of your application, please select “invoice me” on the next screen under the “Billing Details” section. You will receive the invoice by email once your application is approved which you can then forward to your employer for payment instructions.

Select An Option

DEI Expert Exchange

$2500 one-time fee

Enter Contact Information

Prefix (i.e. Mr. Mrs. Dr.)

First Name

Last Name

Suffix (i.e Jr. Sr. III)

Designations

E-mail

Family NameBusiness Name

Please select a valid membership option and fee item if exist