CEOconnex Logo

CEO Connex Application Form:
Confidential
First Name:
Last Name:
Title:
Company:
Street Address:
City, State, Zip , ,
Telephone: (518) -
Fax: (518) -
e-mail:
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)


CEG Logo, Serving New York's Capital Region and Tech Valley

© 2002, Center for Economic Growth. All Rights Reserved
email ceg@ceg.org for assistance if needed.