CEO & Managment Roundtable Application

First Name*

Last Name*

Title*

Company*

Number of Employees*

Estimated Annual Revenue*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Provide information on the specific product/service of your business:*

Select the roundtables you have interest in joining. You may select multiple, but please select at least one:

Roundtable Opportunities:

CEO/President/Owner/Non-Profit Executive Directors
Senior Leadership (CEO, COO, VPs, Non-Profit Executive Directors, General Managers, etc.)
Finance/Accounting (Controllers, CFOs, VPs or Treasurers)
Sales Leadership (VPs of Sales, Sales Managers, Directors, etc. with a focus on Sales Team leadership and goals)
Human Resources (HR Managers, Directors, VPs)
Marketing (Marketing Managers, Directors, VPs)
Sales and Business Development (Individuals in any Sales or Business Development capacity. This group focuses on both business strategy and sharing leads/referrals)
Creative (Creative business owners and management level individuals)

If you selected multiple roundtables above, please RANK your choices in order of preference (1, 2, 3, etc.)

Time of Day*

7:30 a.m.
Noon

Fee is $150 for a twelve month session.
You must be a member in good standing of the Grand Rapids Area Chamber of Commerce to participate. Payment will be processed upon placement.

Each participant of the CEO & Management Roundtable Program is required to sign the Participation/Confidentiality Agreement.

CEO ROUNDTABLE PROGRAM PARTICIPATION/CONFIDENTALITY AGREEMENT

I agree to the following:

I, hereby agree to a commitment of my time, expertise and other requirements of the Grand Rapids Area Chamber of Commerce CEO Roundtable Program. I understand that anyone missing two consecutive meetings or three overall will be automatically dropped from their Roundtable.
I, hereby agree that in order to maintain a level of trust and continuity, it is essential that all meetings and discussions within the group remain strictly confidential. I understand that none of the confidential information shared may be used to cause competitive injury or disadvantage to a participant.
I understand that the CEO Roundtable is not a platform for selling my products or services.

This agreement with the Grand Rapids Area Chamber of Commerce is a commitment of my time, expertise and other requirements of the CEO Roundtable Program.

To agree, simply enter your name and date in the section below after reading this consent.

Confidentiality Agreement signed by:*

First Last

Confidentiality Agreement Signed on:*

Credit Card Information

Credit Card Type*

Visa
Mastercard
Discover
American Express

Credit Card Number*

CVV*

Number on back of card.

Cardholder Name*

Billing Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Card Expiration Month*

Card Expiration Year*

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Select the roundtables you have interest in joining. You may select multiple, but please select at least one:

CEO ROUNDTABLE PROGRAM PARTICIPATION/CONFIDENTALITY AGREEMENT

Credit Card Information

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