Synergen Business Solutions Profile Management Onboarding

Please answer the below questions to the best of your ability and in a timely manner. If you have any questions, concerns, or need further clarification, please reach out to us before completing your submission.

First Name *

Last Name *

Your Post-Nominals and/or Designations *

Your Title *

Your Pronouns *

She/Her

He/Him

They/Them

Please attach your professional bio and/or resume if you need a bio written for you. *

Is there any experience, licensure, or education you would like us to highlight? *

Please upload 12 selfies or former headshots; please make sure you are the ONLY person in the photo. *

If you would like to improve your likeness for your headshots, please upload up to 6 additional selfies or headshots.

By signing your name below, you agree that we may use your likeness, name, and select biographical information for purposes including but not limited to advertising, education, press coverage, and promotions. You understand that you are not entitled to compensation or input regarding its use, but that Synergen Business Solutions and their agents will take appropriate measures to respect your preferences and ensure the responsible and ethical use of your likeness and information. You understand you have the right to revoke this Release at any time by providing written notice of your revocation. You understand that the revocation of this Release will not affect any action taken in reliance on this Release before receiving my revocation. *

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