| |
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| Name : |
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| Last Name : |
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| Age: |
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| Marital Status: |
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| Sex : |
Male
Female |
| Company Name : |
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| Title : |
|
| Business Address : |
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| City : |
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| State : |
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| P.O.Box : |
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| e-mail : |
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| Business Phone, Extension : |
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| Business Fax : |
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| Home Address : |
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| City : |
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| Home Phone : |
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| Home Fax : |
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| I wish to receive mailings at : |
My Home
My Business |
| My email Address : |
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| Please list a few word phrase we could use to describe your Business : |
|
| CEO Club References : |
|
Occasionally, the media asks us to supply names of CEOs who they could interview and we, as a policy,
do not supply any information whatsoever. Please check one of the following: |
|
No, do not supply
Yes, but clear first with me
Yes, anytime |
Membership Type
|
| Associate : |
|
| Corporate : |
|
| 1 Year+CEO 2007 Pass $3,500 : |
|
| One Years $1,200 : |
|
| Two Years $1,850 : |
|
| Three Years $2,300 : |
|
| Lifetime $6,500 : |
|
One Time Initiation
Fee $750 |
|
| Total Enclosed : |
$
|
| Payable to the Kamber
Entertainment Group : |
Yes
No |
| Attached is my credit card
information : |
Yes
No |
| Credit Card Number : |
|
| Expiration Date: |
DD/MM/YY |
This application for CEO Clubs
membership must be accompanied
by
payment before processing and
approval. |
Mission Statement
The Chief Executive Officers Club creates a nurturing environment
for CEOs dedicated to improving the quality and profitability of
their enterprises through shared experience and personal growth.
Information About Applicant’s Business |
| Do you own majority control of your Business? |
Yes
No |
| Please descirbe your business’ products or services: |
|
| What other professional organizations are you a Member of? |
|
| what would your perfect networking location be in the UAE? |
|
| How many employees are in your Organization? |
1 /10
10 /50
50/ 100
150 /500
Over /500 |
| Your annual sales volume is: |
Less than $1 million
$1 to $10 million
$10 to $50 million
$50 to $100 million
Over $100 million |
| Are you a director of your Company? |
Yes
No |
| Is this a family Business? |
yes
No |
| Type of Business: |
Manufacturing
Distribution
Retail
Professional Services
Other |
| Designated alternate (this person will attend when you can’t): |
|
Personal Information
|
|
| Spouse’s Name : |
|
| Names and ages of your children : |
Age :
Age :
Age :
|
| |
|
