Registration Form - Preliminary Information

Please take a moment to complete this survey so we have the appropriate information to ensure a non-competitive group of businesses. For multiple owners, list primary attendee. For co-ownership, list both names if you expect to both attend meetings together. We will be back in touch by phone to confirm your participation in this group. Thank you.

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* 1. Participant Information

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* 2. Company Website

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* 3. List Additional Owner Name/s and Title/s Below:

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* 4. Please check all that apply below:

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* 5. I've been in business for:

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* 6. Number of Full Time Employees (including owner)

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* 7. My business has done the following amount in sales in the past 12 months:

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* 8. Which areas are you currently finding challenging in your business:

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* 9. What do you hope to get out of participation in a PowerLink CEO Circle - Executive Level?

Thank you for completing this information. We will review the businesses and be in touch by phone to finalize the financial commitment and secure your automatic payment information. Questions, please call 412.719.7191 or email stephanie@powerlink.org.

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