CEO & Management Roundtable Application

Thank you for your interest in participating in the CEO & Management Roundtables. Once your information is submitted someone will reach out to you to review the details of the program.
If you would like to know more about the program please call 612-208-3320 to have your questions answered by a representative.

Title

First Name *

Last Name *

Suffix

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Number of Employees *

Estimated Annual Revenue *

Products/Services of Your Organization *

This info will be used to ensure no competitors (or customers of members) are in the same Roundtable

ROUNDTABLE OPPORTUNITIES *

¨ CEO/President/Owner/Non-Profit Executive ¨ Finance/Accounting (Controllers, CFOs, VPs or Treasurers) ¨ Sales Leadership (VPs of Sales, Sales Directors, Sales Managers) ¨ Human Resources (HR VPs, Directors, Managers) ¨ Marketing (Marketing VPs, Directors, Managers) ¨ Technology Roundtable (VPs, Directors, Managers)

Select the roundtables you have interest in joining. You may select more than one, but please select at least one:

If you selected multiple roundtables, please rank order your selections in order of preference (1, 2, 3)

Time of Day Preference *

7:30 a.m. 10:30 a.m. No Preference

FEE

Fee is $325* for Chamber members ($450 for non-members) for a twelve-month period. Paid annually at enrollment. *You must be a member in good standing with the MPLS Chamber of Commerce to get the discounted rate. Payment will be processed upon placement.

PARTICIPATION/CONFIDENTALITY AGREEMENT

I agree with the following: *

	Agree	Disagree
I agree to a commitment of my time and other requirements of the MPLS Chamber Roundtable Program. I understand anyone missing two consecutive meetings, or three overall will be automatically dropped from their Roundtable.	Agree	Disagree

I agree to maintain a level of trust and continuity, it is essential all meetings and discussions within the group remain strictly confidential. I understand none of the confidential information shared may be used to cause competitive injury or disadvantage to a participant.	Agree	Disagree

I understand the Roundtable is not a platform for selling my products or services.	Agree	Disagree


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