Applicant will be billed $60 annual fee once placed in a roundtables group.

Group formation is based upon number of employees, type of business and sales volume. Competitors are not placed in the same group.

Name:
Title:
Company:
Year company was established:
Address:
City:
State:
Zip Code:
Phone Number:
Email:
Referred by:
Applying For:
Primary Goals of Participating in the Chamber's Roundtables:
What are your job responsibilities and degree of accountability for profit and loss? (please be specific)
Number of years of previous business experience:
Number of years with current company:
Number of years in current position:
Type of Business:
Description of product/service:
Number of Employees:
Number of Employees you directly supervise:
Annual Gross Sales Volume:
Business Structure:
Markets Served (check all that apply):
 
Questions?
Call 919.664.7036 or e-mail Meredith Carruthers.

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