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Entrepreneur Exchange Participant Form
Application to participate in an online Entrepreneur Exchange.
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* Indicates required question
Full Name
*
Your answer
Phone
*
Your answer
Mailing Address
*
Your answer
City/Town
*
Your answer
Postal Code
*
Your answer
Email
*
Your answer
Website
(so we can promote you)
Your answer
Blog
(so we can promote you)
Your answer
Twitter
(so we can follow you)
Your answer
Facebook Page
(so we can like you)
Your answer
Tell us about yourself and your idea(s)
*
Please answer the following questions. This information will be used to provide background and help match you with the right expertise. (Please check all that apply)
Inventor
Entrepreneur
Student
Researcher
Investor
Media
Government
Not for Profit
Other:
Required
Please provide a brief description of your topic of conversation or question for The Entrepreneur Exchange (your idea, issue or need):
*
Your answer
What stage is your idea at? (Check one)
*
Thinking - you've got an idea but haven't yet taken actions
Tinkering - you've got an idea and your starting to work with it and take action
Taking off - you've got an idea and it's gaining interest
What stage is your business organization at? (Check, if applicable)
Early-stage
Operating but no revenue
Revenue but not profitable
Profitable and stable cash flow
Clear selection
What is the type of business or organization?
*
Primary agriculture production
Value-added processing
Retail (agricultural product)
Retail (other)
Alternative agriculture production
Manufacturing
Tourism
Marketing and communications
Services
Education and training
Community organization
Community development
Government
Other:
How knowledgeable are you in these areas?
*
Very knowledgeable
Somewhat knowledgeable
Not knowledgeable
Marketing
Financial Management
Product Development
Succession Planning
Governance
Policy
Very knowledgeable
Somewhat knowledgeable
Not knowledgeable
Marketing
Financial Management
Product Development
Succession Planning
Governance
Policy
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