2016 Hudson County CEO Roundtable Application

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* 1. Please let us know who you are:

Name:

Company:

Address:

Address 2:

City/Town:

State:

ZIP:

Country:

Email Address:

Phone Number:

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* 2. Your Title:

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* 3. Type of Business:

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* 4. Please Provide: Total # of Employees/Full-time Employees:

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* 5. Company Website:

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* 6. Gross Revenue for 2013:

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* 7. Gross Revenue for 2014:

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* 8. Profit/Loss for 2013:

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* 9. Profit/Loss for 2014:

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* 10. What specific challenges does your company face?

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* 11. What would you hope to achieve by joining the Hudson County CEO Roundtable?

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* 12. What particular topics would you like the group to discuss?

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* 13. Have you ever belonged to another CEO group? If so, what were your experiences?

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* 14. How will you be a valuable participant in the Hudson County CEO Roundtable?

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* 15. Is there anyone else you recommend to participate in this Roundtable whom the Chamber can invite to join? If yes, please provide their name, company and contact information.

Name

Company

Contact Info

Thank you for your interest in the Hudson County CEO Roundtable. All applications received by September 15, 2015 will be reviewed confidentially by a committee at the Chamber. We will be in touch with you within two weeks of the receipt of your application. If you have any questions or comments, please contact the Hudson County Chamber of Commerce at 201-386-0699.