Civitas -

Join Civitas

Please complete the form below. Thereafter, a Civitas team member will be in touch with you to schedule a meeting and discuss the next steps.

First Name*

Last Name*

Email Address*

Mobile Number (start with +27)*

What city are you based in?*

Cape Town

Durban

Johannesburg

Pretoria

Other (specify below)

Complete if your city is "Other"

What is your LinkedIn profile URL?*

Impressible skills, achievements or accomplishments you would like to share

How many businesses have you founded or held the CEO title (including your current business)?*

1

2

3+

What is the name of your business?*

What is a one-line description of your business?*

What is the website address of your business?

Are you the founder, co-founder, CEO, MD or key decision-maker of the business?*

Yes

No

Are you working full or part-time on your business?*

Full-time

Part-time

What is your primary target market?

SMEs

Corporates

Consumers

Government

Multiple

Other (specify below)

What is your team size, including you?*

1 to 5

5 to 10

10 to 20

20 to 50

50 to 150

150 to 500

500+

What was / is the annual revenue of the largest business or division you have ever managed?*

Less than R1m

R1m to R5m

R5m to R20m

R20m to R50m

R50m to R100m

R100m to R250m

R250m to R500m

R500m to R1b

More than R1b

What is the largest team size that you have managed?*

Never managed a team

1 to 10

11 to 20

21 to 50

50+

Only complete if target market selected is "Other"