CEO Roundtable Application Form

To apply to the program complete the form below and click on the send button at the bottom. After your application is sent the system will display a thank you for applying page.

Applying to the program does not guarantee placement within the program nor does it incur any cost. Membership fees are charged to the member only after acceptance into the program. There are many reasons that applications might be declined and by policy we explain NONE of them. If we can find a good fit for you in the program we will arrange a meeting with the group. After that the group will decide if they want to extend an invitation to you and you will decide if you want to accept it.

Your Name (required)

Your Email (required)

Phone Number

Business Name

Address

City/State/Zip

Number of Employees

Year YOU started as CEO

Year Business was Established

Major Business Challenges

Business Type

Industry

website

Description of Products/Services

Major Business Goals

Approximate Sales Volume

How did you hear about the program?

Have you participated in other Rountable Programs?

Preferred Meeting Time

What other groups or organizations do you belong to?

Comments or Questions

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