The Round Table 12 Application

Applicant Information
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Business Information
Business Name*
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Are you the sole decision maker in the business?*
- Yes
- No
If No, explain*
Questions
What are you going to do in the next year to make your business more profitable?*
What are you passionate about?*
What's the most difficult business obstacle you've faced and how did you overcome it?*
What business issues do you currently have that would need the most attention?*
What value will you bring to the group?*
What else would you like for us to know that has not been asked in this application?
Disclaimer and Signature
Disclaimer*
I agree to these terms.
I certify that my answers are true and complete to the best of my knowledge.

If this application leads to acceptance of membership in Roundtable 12, I understand that false or misleading information in my application or interview may result in my release.
Date*
MM slash DD slash YYYY
Signature*
Email
This field is for validation purposes and should be left unchanged.

Applicant Information