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CEO Connex Application Form:
First Name:
Last Name:
Street Address:
City, State, Zip , ,
Telephone: (518) -
Fax: (518) -
Year founded (xxxx):
Previous Year Revenue:
5 Year Revenue Growth Goal:
Technology Sector:
Number of Employees:
Please provide a short
description of your
technology, product, or business
(under 50 words):
What is the biggest challenge you face in growing your business? (Under 50 words)
Why do you want to participate in Ceo Connex? (under 50 words):
Which of the following do you hope to work on as part of your participation in CEOconnex?
(Ctrl + click to select multiple items)

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