Goering Center Roundtable Membership Application
Thank you for your interest in joining a Roundtable through the Goering Center for Family and Private Business. Please complete the following application. (Fields marked with * are required).
Personal and Professional Information
Full Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Company Information
Company Info
*
Current Title/Position
Organization/Company
Industry
*
Company Website
*
Location
*
Street Address 1
Street Address 2
City
State / Province
Postal / Zip Code
Decision-Making Authority
I am...
*
The owner
Part of Senior Leadership
Other
Knowledge, Skills and Experience
Define your areas of expertise as well as any relevant experience.
*
Roundtable-Specific Questions
What are your goals for the coming year?
*
What are your biggest business obstacles? What challenges have you overcome?
*
What business issues need the most attention?
*
What knowledge, expertise and experience will you add to your Roundtable group?
*
Terms and Conditions
Agreement to Rules and Regulations
*
All members understand and agree to abide by the roundtable's rules and guideline.
Confidentiality Agreement
*
All members understand and agree to total confidentiality of all discussions and materials, both while a member and any time thereafter.
Membership Fee
*
All members agree to pay their annual membership fee upon receipt.
Signature
*
Date
*
-
Month
-
Day
Year
Date
Additional Information (Optional)
Please provide any relevant materials to this application
LinkedIn Profile
Resume
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Do you have any restrictions regarding meeting dates/times or geographic location? If so, please explain.
Submit
Submit
Should be Empty: