Global Top 100 Innovators in Information Security - Self Nomination

Nominate yourself to be featured within The Global Top 100 Innovators in Information Security 2022 list.

This nomination form will take approximately 10 minutes to complete. Please answer as fully as you can. Any questions about the nomination process please email: catherine.king@coriniumgroup.com

Basic Information - In this section please submit your details.

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. What is your current job title?

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* 4. What is the name of the organisation/company you work for?

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* 5. What is your work email address?

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* 6. Please include a link to your LinkedIn profile:

Nomination Information - In this section please submit the details of why you are making the nomination.

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* 7. Where are you based (city & country)?

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* 8. What have you achieved within the information security community to deserve recognition and the reward of being placed in our Global Top 100 Innovators 2022 list?

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* 9. Please could you give detailed examples of how you've been active within the information security community? (This could be writing blogs, speaking at events, engaging in a mentorship program - in the next question you will be able to upload supporting documents).

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* 10. Please attach any relevant documents to support your nomination. For example, articles/reports where you have contributed.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 11. Please upload a professional headshot that you'd like us to use if your nomination is successful. (Please ensure it is high quality and in color)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 12. Please give details (name & email) of one person we could reach out to if you're successful to interview about your achievements. (This could be a colleague or someone who has followed your infosec journey.)

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* 13. Please provide a professional bio that you'd like us to use if your nomination is successful.

Diversity & Inclusion - The sole purpose of this section is for equality and diversity assurance. You may skip this section if you wish.

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* 14. What age category are you?

Under 25

26-35

36-45

46-55

56-65

65+

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* 15. What best describes your gender:

Female

Male

Prefer not to say

Prefer to self-describe:

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* 16. What is your sexual orientation:

Heterosexual / Straight

Gay Man

Gay Woman / Lesbian

Prefer not to say

Prefer to self-describe:

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* 17. Please state your ethnicity (or skip to the next question):

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* 18. Please state your religion (if applicable, or skip to the next question):

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* 19. Do you consider yourself to have a disability (or skip to the next question)?

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* 20. If you're not already, would you like to subscribe to the Business of InfoSec for exclusive reports, articles, video content, and more?

Yes

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* 21. Would you like to find out more about InfoSec events taking place in your region?

Yes