CEOC Event Registration Form

The
Rhode Island
CEO Council

Increasing Business Performance, Economic Growth, and Quality of Life in Rhode Island

Participants are seated with peers—chief executives with similar sized workforces

Please Provide All Information Requested

— All information provided will be kept confidential —

Select Event

Name & Date:

Your Name & Title:

Full Formal Name:

Name on Badge - First: Last:

Current Job Title:

The organization you lead:

Type of Organization

Org Name:

Address:

City: State: Zip:

Workforce Size: Number of Employees:

Number of Employees must be consistent with Workforce Size

Description of Business:

Business Website:

Your contact info:

email:

Office Phone (direct): Mobile:

Executive Assistant (optional):

First Name: Last:

email: Phone:

Preferred way for us to contact you:

Attendee Agreement:

I have read and agree to abide by the Rhode Island CEO Council's Member & Guest Principles:

eSignature:

Registration Fee:

(Includes a 30-day reduction of the new member enrollment fee)

Qualified Chief Executive: $175 registration fee

Invited Guest of: (registration fee covered by member)

Any Special Needs?

ROBOT CHECK