Executive Roundtable Application
2018 Arizona Technology Council Phoenix Executive Roundtable Application
Email address *
Name *
Date *
MM
/
DD
/
YYYY
Company Name *
Job Title *
Owner *
% Ownership (if applicable)
Educational background (please attach resume or biography): *
Required
Office Phone
Mobile Phone
Years in Position *
Assistant's Name
Assistant's Email Address + Phone
Company Address *
Annual Revenue *
When was the company founded? *
Number of Full-Time Employees *
Number of Part-Time Employees *
Company Website *
Describe core product(s) and/or service(s): *
Current business challenges: *
Skills, Competencies, + Experience (check all that apply)
A copy of your responses will be emailed to the address you provided.
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