Center for Economic Growth

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)
I understand that if I am accepted into the CEOconnex program I will be asked to remit a $1,850 enrollment fee and that I am committing to attend CEOconnex sessions the second Tuesday of each month from September through June.	Yes, I understand.