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:
Under $1M
$1M - $5M
$5M - $10M
$10M - $20M
Over $20M
5 Year Revenue Growth Goal:
Under $5M
$5M - $10M
$10M - $20M
Over $20M
Technology Sector:
Advanced Materials
Biotechnology
Energy
Information Technology
Nanotechnology
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)
Hiring and Human Resource Management
Selling Process and Techniques
Product Marketing and Business Development
Venture and Angel Funding
Advisory Board Development
Operations Scale-Up
Team Building
Strategic Planning
Other
© 2002, Center for Economic Growth. All Rights Reserved
email
ceg@ceg.org
for assistance if needed.
