Thank you for your interest in this historic Executive Leadership Exchange with China. Please complete the request information below. Upon review, we will notify you electronically and/or via telephone of your tentative acceptance into Black Card Circles exclusive program with China's Exclusive Leadership Academy Pudong (CELAP).

Please note:  Your acceptance into Black Card Circle's Executive Leadership Exchange (ELE) is subject to Chinese Central Government approval!

  • Name *
    Title
    First
    Last
    Suffix
     
  • Company *
  • Company Title *
  • Company Address *
    Street Address
    Address Line 2
    City
    State / Province / Region
    Zip / Postal Code
    Country
     
  • Email Address
  • Phone Number *
    (###)
    -
    ###
    -
    ####
     
  • Preferred Contact Method *
    Email
    Phone
    Either / Both
  • Assistant Name
  • Industry *
  • Yearly Revenues *
  • Number of Employees *
  • Company Website URL *
  • Company Description *
  • Foreign Language competency
    Please tell us if you speak or understand a foreign language, and indicate your proficiency below:
  • Read
    Write
    Speak
  • Interest in program *
    Networking
    Business Export
    Business Import
  • Honors and Distinctions
  • Personal Statement/Qualifications *