GFW Inc. CEO Roundtable Application - Greater Fort Wayne Inc.

GFW Inc. CEO Roundtable Application

Fields marked with an * are required.

Your Information

First Name *

Last Name *

Are you a current member of Greater Fort Wayne Inc.? *

GFW Inc. CEO Roundtables are open to active GFW Inc. Members only. Individuals may not be voted into/remain in a CEO Roundtable as a participant if their company is not an active GFW Inc. Member company.

Organization *

What is your current company?

Title *

CEOs (including C-Suite), senior executives, who report directly to the C-Suite, executive directors, presidents, and owners of small and mid-size companies regardless of title, may join a CEO Roundtable. Individuals with for profit and nonprofit entities may participate.

Email *

Phone *

Do you need any special accommodations to participate in a CEO Roundtable?

How did you hear about the CEO Roundtable program? (check all that apply)

GFW Inc. Staff Referral

GFW Inc. Board Referral

GFW Inc. Website

Invited by Colleague

Other

Company Information

Company Website *

Business Industry/Specialty *

Please be as specific as possible; e.g., commercial real estate vs. residential, medical insurance vs. P&C

Briefly describe the products/services offered by your business. *

Year company founded/established *

Executive Experience

Briefly describe the primary responsibilities of your CURRENT role *

How many years have you been at an executive level with your CURRENT company? *

Describe previous job history with your CURRENT company? *

Please highlight your PREVIOUS executive experience *

What business challenges would you like to resolve by joining a CEO Roundtable?

What areas of expertise do you bring to the CEO Roundtable program?

Have you participated in other roundtable programs in the past? *

Personal References

Please list your first reference's Full Name, Email, and Company *

Please list your second reference's Full Name, Email, and Company *

Please list your third reference's Full Name, Email, and Company *

CEO Roundtable Selection
Please rank, in order of preference, the CEO Roundtable you'd like to visit. The process includes the following: Indicate your preference on which groups you prefer to visit. Once the application is received, the identified CEO Roundtable chairs will be notified to schedule your visit. After a mutual decision between you and the preferred CEO Roundtable is decided, the chair will ensure you’re voted in with a $50 invoice following for the annual membership.

CEO Roundtable Choice #1 *

CEO Roundtable Choice #2 *

CEO Roundtable Choice #3 *

Agreement to Policies and Procedures
I have read and agree to the GFW Inc. CEO Roundtable Policies & Procedures document and understand that I am permitted to visit a maximum of ONCE to any roundtable with an opening for my specialty/category in the billing year (January to December) before vote is required for official membership in that group. I understand GFW Inc. staff will strictly enforce that I CANNOT visit/join any CEO Roundtable where the policies or procedures are not followed.

Click to indicate your acceptance of the policies and procedures. *

Digital Signature *

Please type your name indicating everything submitted on this application is true.

Please verify that you have checked the “I'm not a robot” checkbox.