Online application

Please take a moment to provide us with some basic details about yourself and your company. We will use these details to ensure you are properly placed into the appropriate peer-group. Information provided to CEO-CF is completely confidential and will not be shared in any way. The information will be used only to assess the appropriateness of the value proposition of CEO-CF and to assist in the Admission Process between the applicant and CEO-CF staff.

If selected for membership, the annual dues include attendance at three CEO-Collaborative Forum meetings (with a peer group of approximately 15 other non-competitive companies), and include access to the CEO-Collaborative E-Forum ™ and other 24/7 services.

Fields marked with a * are required.

About you

First name: *

Last name: *

Email: *

Mobile: *

Telephone:

What is your nationality?:

Please enter your current position within your company: * select...CEO - FounderCEO - HiredManaging DirectorCFO / Finance DirectorBoard Member / Chairman

In total, including your current role, how many years experience do you have as an Executive?: select...<12345678910>10

Company Information

Company Name: *

Website:

In which country is your company registered?:

Company Figures

What are your company's (estimated) revenues (in Euros) and full-time employees for 2009 and 2010?

2011 Revenue (€): select...<1.0-2.0M2.0-5.0M5.0-10.0M10.0-25.0M25.0M-50.0M50.0-75.0M75.0-100.0M>100.0M

Projected 2012 Revenue (€): select...<1.0-2.0M2.0-5.0M5.0-10.0M10.0-25.0M25.0M-50.0M50.0-75.0M75.0-100.0M>100.0M

2011 Employees: select...<1011-2021-5050-100101-200>200

Projected 2012 Employees: select...<1011-2021-5050-100101-200>200

Industry:

Clean Technology

Financial Services

Health / Life Sciences

Human Resources / HR Systems

IT Software and Services

Social Media, Media & Advertising

Services & Retail

Mobile software, services & Hardware

Manufacturing

Geographic Markets:

Board of Directors

Does your company have a Board of Directors?: select...YesNo

If yes, how long has it been in place?:

Have you raised funds?: select...YesNo

If yes, how much and when?:

The Community

Do you know any of the CEO-CF members? (Member list can be found here):

No

Yes

If yes, please identify who:

Please tell us how you found out about CEO-CF:

What do you want most from being a member of the CEO-CF community?:

What is the most significant experience that you will bring into your CEO-CF group?:

Availability

Which of the dates below are you available to attend the next CEO-CF meeting?

Open Day - Barcelona:

24 January

Open Day - Silicon Valley :

03 February

Open Day - Lisbon:

14 February

Spring Member Meeting - Barcelona:

11-13 March

Open Day - Lausanne:

12 April

Open Day - London:

26 April

Open Pan Euro - Lisbon:

17-19 June

Fall Member Meeting - London:

14-16 October

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