Greater Baltimore Technology Council - Executives Roundtable Application

Bioscience Executives Roundtable CEO Executives Roundtable Government Contracting Roundtable Marketing Executives Roundtable Product Roundtable Emerging Companies Roundtable
Company Information:
Company Name:
Address:

City:	State:
Zip Code:	Geographical Area:
Number of Employees:
Brief Company Description:
Individual Information:
Name:	Title:
Phone:	Fax:
Email:
Bio/Background:
General Information:
3 reasons why you want to participate in the Executive Roundtable: Reason 1: Reason 2: Reason 3:

What experience/expertise do you bring to the group?
What are some of the issues confronting you now?