CyberLeader Application Name* Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Last Suffix Title* Email* Let us know if any of the following apply to youMembership is free for educators, nonprofits, public servants, and students. We’ll verify your selection when we review your application. I work for a nonprofit I work in education I work in law enforcement I work for government I am a full time student None of the above Allow people to contact you through the website? Yes No Linkedin or Bio Url* Headshot*Accepted file types: jpg, jpeg, png, Max. file size: 2 MB.Please submit a head shot for your entry. A high quality image between 800px 1200px in width is suggested. Name of Business or Organization* Organization Website* City* State / Province / Region* Postal Code* Country*AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua & DepsArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia HerzegovinaBotswanaBrazilBruneiBulgariaBurkinaBurundiCambodiaCameroonCanadaCape VerdeCentral African RepChadChileChinaColombiaComorosCongoCongo {Democratic Rep}Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIreland {Republic}IsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar, {Burma}NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussian FederationRwandaSt Kitts & NevisSt LuciaSaint Vincent & the GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweReferred by Cybersecurity Areas of Interest* Cyber Crime Risks and Threats Cyber Education & Workforce Development Cyberbullying CyberResilience Cybersecurity & Privacy Laws and Regulations Cybersecurity for Everyone Cybersecurity Governance Cybersecurity Leadership & Culture Cybersecurity National Policy Cybersecurity Risk Management Disinformation Misinformation & Fake News Diversions Diversity Diversity, Equity & Inclusion eDiscovery Election Security Equity & Inclusion Financial Cybersecurity Frameworks & Best Practices Identity Theft Information Security Management / MSSP Investigations and Forensics KnowTheEnemy Law Enforcement National Cybersecurity Other Payment Card Industry (PCI-DSS) Personal Cyber-Privacy Privacy Management Ransomware Reasonable Cybersecurity Reasonable Cybersecurity Practices Risk Management / Insurance Scam Secure The Human SecureTheVillage Security Management of IT Network Supply Chain Security Professional Cybersecurity Involvement: Tell us about yourself*Enter a description of you / your organization and the services you provide as you would like it to appear in your listing. If you are a speaker, be sure to include information about your speaking services. Industry*Select One Accounting and Audit Aerospace / Defense Agriculture Banking and Financial Services Biotech Brokerages / Wealth Management Construction / Architecture / Engineering Consulting (Management / Strategy / Leadership / Finance /HR / etc) Consumer Retail Digital Infrastructure (Telecommunications / Cloud Services / etc) eCommerce Education Food & Beverage Government Health Care (Medical / Wellness / etc) Hospitality Information Security and Privacy Management / MSSP Insurance (Personal / Commercial / Employee Benefits /etc) Labor Organizations Law Law Enforcement Managed Service Providers (MSP) / IT Manufacturing & Distribution Media and Entertainment Natural Resources / Energy / etc Nonprofit Organizations Political Organizations Real Estate Research & Development Residents (Individuals and Families) Semiconductor Industry Transportation Utilities May we call on you to volunteer?* Yes No Can you host a leadership meeting?* Yes No Do you provide speaker services?* If yes, please include cybersecurity titles / topics / descriptions in your Professional Cybersecurity Involvement above. Yes, For a fee Yes, Pro bono Yes, both fee and pro bono No Are you a service provider?* Yes No Services Provided* Cyber Crime Risks and Threats Cyber Education & Workforce Development Cyberbullying CyberResilience Cybersecurity & Privacy Laws and Regulations Cybersecurity for Everyone Cybersecurity Governance Cybersecurity Leadership & Culture Cybersecurity National Policy Cybersecurity Risk Management Disinformation Misinformation & Fake News Diversions Diversity Diversity, Equity & Inclusion eDiscovery Election Security Equity & Inclusion Financial Cybersecurity Frameworks & Best Practices Identity Theft Information Security Management / MSSP Investigations and Forensics KnowTheEnemy Law Enforcement National Cybersecurity Other Payment Card Industry (PCI-DSS) Personal Cyber-Privacy Privacy Management Ransomware Reasonable Cybersecurity Reasonable Cybersecurity Practices Risk Management / Insurance Scam Secure The Human SecureTheVillage Security Management of IT Network Supply Chain Security Industries Served*Select all that apply Accounting and Audit Aerospace / Defense Agriculture Banking and Financial Services Biotech Brokerages / Wealth Management Construction / Architecture / Engineering Consulting (Management / Strategy / Leadership / Finance /HR / etc) Consumer Retail Digital Infrastructure (Telecommunications / Cloud Services / etc) eCommerce Education Food & Beverage Government Health Care (Medical / Wellness / etc) Hospitality Information Security and Privacy Management / MSSP Insurance (Personal / Commercial / Employee Benefits /etc) Labor Organizations Law Law Enforcement Managed Service Providers (MSP) / IT Manufacturing & Distribution Media and Entertainment Natural Resources / Energy / etc Nonprofit Organizations Political Organizations Real Estate Research & Development Residents (Individuals and Families) Semiconductor Industry Transportation Utilities What Size Clients / Customers Do You Support?*Select all that apply Fortune 1000 Mid to Large Organizations Small to Medium Organizations Small and Home Office Residents What's your service range?* Global National Regional Local Generally, what types of individuals seek your services?* All Audiences – General Application Developers Attorneys Attorneys – Cyber Boards of Directors CIOs CIOs, CTOs, IT Directors CISOs CISOs, Information Security Managers CTOs Cyber Policy Cyber Risk Managers / Insurance Brokers Cybersecurity Educators Cybersecurity Students Executives Financial Service Professionals HR Professionals Information Security Managers IT Directors Law Enforcement Other Business Professionals Residents (Individuals and Families) Small Business Small Office Home Office (SOHO) Just in case the options we provided did not adequately categorize your services, let us know here.CyberGuardian PledgeTake the Pledge*CyberLeaders are also CyberGuardians. As a CyberGuardian, I pledge to: 1. Stay informed about cyber risks, threats, vulnerabilities, and defensive measures. 2. Protect my own and my family’s important information and our computing devices. 3. Share my cybersecurity knowledge and expertise with village residents. I agree to uphold the CyberGuardian pledgePaymentFeeMembership Fee $0.00 Credit Card*Card Details Cardholder Name CommentsThis field is for validation purposes and should be left unchanged. Δ