LanceWinslow@LanceWinslow.org
	
	You may use this short form below and if you appear to 
	qualify to run an International Think Tank in conjunction with the Online 
	Think Tank we will later mail you the long form. 
	You may cut and past this form into an email and simply answer the questions 
	below. We thank you in advance for your consideration.
	 
	International Think Tank Short Form
	1.  Name:
	
	2.  E-mail Address:
	
	3.  Address, City, State, Country:
	
	4.  Fields of Knowledge and areas of Expertise:
	
	5.  Contributions to Society, Industry, Government:
	
	6.  Contributions to Community:
	
	7.  Academic Credentials:
	
	8.  Reason for Interest:
	
	9.  How did you hear about us: