Personal Information

First Name *

Last Name *

Email *

Phone *

LinkedIn Profile *

Location (City, State, Country)

How did you hear about Portrayals XR? *

By submitting this form, you agree to receive text messages and phone calls from Portrayals XR at the number provided. These communications may include automated messages, pre-recorded calls, or AI-assisted voice technology, and may be used for marketing, appointment scheduling, follow-ups, demos, or service-related information. You understand that consent is not a condition of purchase. You may opt out at any time by replying STOP to any text message or by contacting Portrayals XR directly.

Professional Background

Which category best describes your expertise? (Select all that apply) *

Other

Please briefly summarize your professional background and current role. *

What unique perspective, experience, or expertise would you bring to the Portrayals XR Advisory Board? *

Values & Alignment

Have you had personal or professional experience with emotional healing, trauma work, or immersive wellness? If so, please share what has impacted you most. *

Why are you drawn to the mission of Portrayals XR? *

In your own words, how do you define transformational healing? *

Are there specific populations, causes, or innovations you are particularly passionate about? *

What networks or connections do you have that could be beneficial to our organization? *

Availability & Expectations

Our advisory board meets every two weeks and may require 3–5 hours/month (slightly more during the early stages). Are you able to commit to this level of involvement? *

Would you be open to additional opportunities to support the mission (e.g., networking, speaking, collaborating on pilots)? *

Professional Background & Expertise

Have you previously served on any advisory boards?

If so, what was your role and impact?

Have you ever worked with a startup? If so, at what point did you join, and did you stay through exit?

Conflicts, Ethics & Legal

Do you currently serve on any other boards or advisory roles? Could any present a conflict of interest?

Are you affiliated with any companies or investors that overlap with our market or competitor space?

Have you ever been involved in a legal dispute or regulatory issue as part of a board or executive role? *

Final Thoughts

Tell us one professional strength you bring to the table and one area where you know you’re still learning. *

What excites you most about the future of mental health, immersive healing, or consciousness work? *

Is there anything else you'd like us to know about you? What makes you unique? *