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| First Name : * |
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| Middle Name : |
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| Last Name : * |
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| Nick 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 : * |
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| Business Address : * |
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| City : * |
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| P.O.Box : |
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| Country : * |
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| E-mail : * |
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| Website : |
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| Business Phone, Extension : * |
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| Mobile : * |
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| Business Fax : |
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| Mailing Address : * |
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| I wish to receive mailings at : |
My Home
My Business |
| My email Address : * |
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| If Any CEO Club Member References : |
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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: |
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No, do not supply
Yes, but clear first with me
Yes, anytime |
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Membership Type * |
| Corporate : |
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| One Years $1,950 : |
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| Two Years $2,600 : |
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| Three Years $3,050 : |
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| Fifteen Years $7,250 : |
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| Total Enclosed : |
$
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Payment Type : * |
| Credit Card: |
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| PayPal : |
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| By Cheque : |
Cheque payable to the "CEO CLUBS"
mail with application to:
CEO CLUBS UAE
P. O. Box 58162
Dubai, UAE |
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Information About Applicant’s Business |
| Please descirbe your business’ products or services: * |
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| What other organizations are you a Member of? |
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| What would your perfect networking location be in the UAE? |
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| 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): |
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Personal Information (Optional) |
| Spouse’s Name : |
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| Names and ages of your children : |
Age :
Age :
Age :
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| Please describe any special areas of expertise or your hobbies: |
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| All CEO CLUBS membership application form with
payment will be process |
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Enter Code Below
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