MEMBERSHIP FORM


* Company:
* First Name:
Middle Name:
* Last Name:
* Email:
* Password:
Title:
Address:

City:
State:
Zip Code:
* Phone:
Fax:
Website:
Headshot:
Birthday:	/
Spouse/Sig. Other:
Executive Assistant:
Executive Assistant Email:
Executive Assistant Phone:
Business Description:
Business Category:
Total Employees:	2005: 2006: 2007: 2008: 2009: 2010: 2011: (projected)
Gross Annual Sales:	2005: mil. 2006: mil. 2007: mil. 2008: mil. 2009: mil. 2010: mil. 2011: mil. (projected)
Year Co. Founded:
Business Recognition:
Are you in other CEO organizations?:
Name your top business challenges:
What topics would you like to see addressed at future meetings:

If you were asked to be a "subject matter expert" with media or to speak to other CEOs, what would be your area(s) of expertise?

What has brought you to where you are today, as a leader and as a person? Where have you been before, what did you do then, and how does this differ?

What don't we know about you that others might be interested in knowing?

What are some of your challenges and opportunities as CEO? How have they changed over time? How did you overcome or meet them?

What motivates you to lead your company?

Please tell us an interesting story about your leadership experiences in less than 100 words.

How did you hear about the CEO Council?

UPCOMING EVENTS

April 8, 2010
Leadership Strategy: OVERCOMING TEAM DYSFUNCTIONS
Chris Young
Centre Club
123 S. Westshore Blvd.
7:00 AM - 9:00 AM

May 13, 2010
THE BIGNESS OF SMALLNESS
John Moore
Centre Club
123 S. Westshore Blvd.
7:00 AM - 9:00 AM

Chris Young
Founder, The Rainmaker Group
April 8, 2010

Speaker Howard Hyden (left) and
Karen Arnold, former chair (right)
welcome new faces.