Biography Request Form

Please Fill Out the Form Below

If you have any questions please call 413.787.1133.

*Required

GENERAL

Full name you use professionally*

Company*

Work address*

Work email*

Work phone number/extension: (4135555555)*

Are you on LinkedIn?*

YesNo

PROFESSIONAL

Current title*

Previous titles held (if any) at this company*

Years in current role*

Years with current company*

Describe your current roles and responsibilities*

Total number of years in your field*

Most recent relevant previous employment (include title, role and responsibilities, length of service)*

Professional awards and recognitions you have received

EDUCATION (IF APPLICABLE)

Name of college/university

Degree

Year completed

Name of college/university

Degree

Year completed

Name of college/university

Degree

Year completed

Other credentials/certifications

MILITARY SERVICE

Branch

Rank

Years served

PERSONAL

Please share personal information to the extent your are comfortable.

City/State of residence (helps with pick-up of press releases)

Family (spouse/partner, children, grandchildren)

Hobbies/activities

Personal awards/recognitions/achievements (include year received)

Community service (please describe)

ANYTHING ELSE?

The bios we develop are based on your company's style, but please let us know if there is anything else you would like us to include, if appropriate.

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