Business Snapshot
Full Name
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Email
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Company Name:
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Your Role
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Your Annual Revenue:
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Current CEO Challenge
What is the most important decision or leadership challenge currently on your plate?
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CEO Readiness
What do you hope to gain from participating in a peer CEO roundtable?
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How You Show Up
The CEO Roundtable is built on discretion, candor, and accountability. How do you typically contribute in peer leadership conversations?
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I listen carefully and reflect before speaking
I ask questions that help others think more clearly
I try to fix other people’s problems or tell them what to do
I’m comfortable being direct and being challenged
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Comment (optional - 1 sentence)
Commitment & Fit
CEO Roundtable meets monthly for 90 minutes and requires preparation, confidentiality, and follow-through. Are you able to commit to this level of participation for 12 months?
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Yes
No
I’d like to discuss further
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Topics
Which specific topics would you like to focus on during this CEO Roundtable ?
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