Form

This information is used by Butterfly Works to better understand the makeup of the community and how we can best support members. It will not be shared without your express permission.

First name*

Last name*

Email*

Phone number

What is your country of origin?*

What is your country of residence (where you currently live)*

What city do you currently live in?

What is your gender?*

What is your birthdate?*

To change the year and month, click on the top bar with the bolded date (month and year)

Year/Month/Day

What is the name of the organization or initiative where you are working?*

What is your current job title?*

Which title best describes your role?*

Why do you want to join Butterfly Works' Community of Practice?*

Please select the most important reason

Describe what you look forward to offering the community:

Describe what you hope to gain from the community: