MEMBERSHIP FORM

Thank you for your interest in the CEO Council. We strongly recommend you first download and save our Membership Consideration form in PDF format. You may type your information directly into the PDF document, and save the file on your computer to avoid any potential loss of your answers. After completing this PDF document, you may transfer the information to our online form on this page and submit for consideration and payment, or email the information to ceos@tampabay.rr.com.
* Company:  
* Salutation:
* First Name:  
Middle Name:
* Last Name:  
* Email:
* Password:  
Title:
Address:
 
City:
State:
Zip Code:
* Phone:  
Fax:
Website:
Headshot:
Home Address:
 
Home City:
Home State:
Home Zip Code:
Home Phone:
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:
Emerging:
Source:
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

June 14, 2012
Leadership When the Heat is On
Major General Karl R. Horst
Centre Club
123 S. Westshore Blvd, Tampa 33609 (Urban Centre, 8th Floor)
7:00 AM - 9:00 AM

July 12, 2012
"Our Age of Transformation: Major Trends in the 21st Century"
Peter Leyden
Centre Club
123 S. Westshore Blvd, Tampa 33609 (Urban Centre, 8th Floor)
7:00 AM - 9:00 AM

SPEAKER HIGHLIGHT

Major General Karl R. Horst
Chief of Staff, Central Command, MacDill AFB
June 14, 2012



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