CEO Group Application Please check which CEO Group you are applying for: Business Cycle Start-up/Solopreneur CEO Group ($350/year)Established CEO Group ($650/year)Million Dollar CEO Group ($850/year) Applicant Information Applicant Name * First Last * Last Email Address * Cell Phone Work Phone Business Information Business Name Business Address Business Address Business Address Business Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Business Website Company Type (C Corp, S Corp, LLC, etc.) Business Description: (nature of business; product or service; target market) Date Business Created 2023 Annual Revenues Number of full-time employees Number of part-time employees Number of contract workers How many employees/contractors in total do you plan to hire in the next 24 months Type of financing to date Describe the major business challenges that you want to address Please provide 3 to 5 reasons for why you would like to join a CEO Group and your specific goals or objectives from the group Terms and conditions * By checking this box, I accept the terms and conditions listed above. CEO Group Terms Applicant certifies that all facts, figures and representations made and provided in this application process are true, correct, and consistent with the purposes and requirements of the Program. Applicant agrees to sign a Confidentiality Agreement before attending a CEO Group Meeting. Applicant commits to attend at least 80% of CEO group meetings. To the fullest extent permitted by the law, applicant will indemnify, defend and hold harmless the Enterprise Center at Salem State University and its respective representatives, shareholders, affiliates, agents, and employees for and against any loss, suit, liability, claim, damage, or expense, whether or not involving a third-party claim, arising directly or indirectly, from or in connection with applicant’s involvement with the CEO Group. Applicant will not name the Enterprise Center at Salem State University or its respective representatives, affiliates, or agents in any suit, arbitration, or legal matter; any loan, guaranty, credit, note, application, agreement, contract or any other similarly related transactional document or otherwise bind or in debt the Enterprise Center at Salem State University in any way. Today's Date * reCAPTCHA If you are human, leave this field blank. Submit Δ
