Greater Fort Wayne Inc. CEO Roundtables Application

CEO Roundtables Application
Is your company a current member of Greater Fort Wayne Inc. or does it have a membership application pending? (If “No,” please submit a GFW Inc. membership application, then return to this application to complete the process. Not sure if you're a member? Search our Business Directory - all GFW Inc. members are listed there.)*

YesNo
Are you an active member of the GFW Inc. Bridge Program?*

YesNo

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

GFW Inc. staff/board referralGFW Inc. eventGFW Inc. websiteWord of mouth/invited by colleagueOther
If "other," please specify:

Company Profile

Tell us about your company.
Business Industry/Specialty: (Please be as specific as possible; e.g., commercial real estate vs. residential, medical insurance vs. P&C)*
Please briefly describe the products/services offered by your business.*
Year company founded/established*
What are the current goals/projections for the company?*
Approximate annual revenue for a typical year*

Less than $50,000$50,000 - $250,000$250,000 - $500,000$500,000 - $2 million$2 million - $5 million

Executive Experience

Please tell us about your experience.
Please briefly describe the primary responsibilities of your CURRENT role.*
How many years have you been at an executive level with your CURRENT company?*
What previous job history do you have with your CURRENT company?*
Please highlight your PREVIOUS executive experience:*
Have you participated in other roundtable programs in the past?*

YesNo
If asked, would you be willing to serve as roundtable chair/president?*

YesNo
What areas of expertise do you bring to the CEO Roundtable program?*
What business challenges would you like to resolve by joining a CEO Roundtable?*

Do you need any special accommodations to participate in a CEO Roundtable? If yes, please describe here:

CEO Roundtable Rankings

Please rank, in order of preference, the CEO Roundtable you'd like to visit. If a group already has a member from your industry/specialty, please do not include it in your rankings. You can see the current roster by clicking on the following link https://greaterfortwayn-my.sharepoint.com/:x:/g/personal/lhannah_greaterfortwayneinc_com/EX7l82UyGN1Jn5IdJmbugWMBGBECompHAcSxAJ_KExZaNg. 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.
First Preference*
Second Preference*
Third Preference*

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.*

I agree to the policies and procedures.
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CEO Roundtables Application