Expert Authority

To become a contributing member as an Expert Authority, please complete the following information. If a given field is not applicable to your situation, simply enter “N/A” in that field.

 

Prefix (Dr. Mr. Etc):

First Name:

Last Name:

Street Address 1:

Street Address 2:

City:

State/Prov:

Zip/Postal Code:

Day Phone:

Night Phone:

Cell Phone:

Fax Number:

EMail Address:

If the following information is available on the Internet, simply indicate the URL in the applicable box. If the information is not available on the Internet but can be sent via email, please indicate as such in each applicable box and send it to memapp@expertsources.org 

Educational Background: please list all degrees including university name(s), dates, and areas of concentration:

Please indicate which areas of expertise you wish to bring to the Expert Source Bureau:

Please provide an abbreviated list of any media exposure you may have had:

Please provide an abbreviated list of any books you may have published:

Please provide an abbreviated list of publications in which your articles have been published:

After pressing the “Submit” button and the “hour glass” disappears, please use the buttons in the upper left to navigate throughout the website.

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