First Name : *

Middle Name :

Last Name : *

Nick Name :

Age:

Marital Status:

Sex : *

  Male Female

Company Name : *

Title : *

Business Address : *

City : *

P.O.Box :

Country : *

E-mail : *

Website :

Business Phone, Extension : *

Mobile : *

Business Fax :

Mailing Address : *

I wish to receive mailings at :

My Home My Business

My email Address : *

Recommending MAS's CEO Club Member's name:

Occasionally, the media asks us to supply names of CEOs who they could interview and we, as a policy,
do not supply any information whatsoever. Please select one of the following:    No, do not supply Yes, but first verify with me Yes, anytime

Membership Type * 

Corporate :

Associate Membership One Years $600 :

Full Membership One Years $2,400 :

Lifetime Membership  $10,000 :

Lifetime Membership Payment Plan  $2,500 :

Total Enclosed :

$

Payment Type : *

Credit Card:

PayPal :

By Check  :

Cheque payable to the "CEO CLUBS" mail with application to:
      CEO CLUBS UAE
      P. O. Box 58162
      Dubai, UAE

Information About Applicant’s Business

Please describe your business’ products or services: *

What other organizations are you a Member of?

What would your perfect networking location be in the UAE?

How many employees are in your Organization? *

  1-10 10-50 50-100 150-500 Over 500

Your annual sales volume is: *

  Less than $2 million $2 - $10 Million $10 - $50 million $50 - $100 million Over $100 million

Are you a director of your Company?

Yes No

Is this a family Business?

Yes No

Type of Business:

Manufacturing Distribution Retail Professional Services Other   If other, Please Specify

Designated alternate (this person will attend when you can’t):

Personal Information (Optional)

Spouse’s Name :

Names and ages of your children :

Name :     Age :
Name :     Age :
Name :     Age :
 

Please describe any special areas of expertise or your hobbies:

All CEO CLUBS membership application form with payment will be process