GNHBPA Membership Form

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If interested in becoming a GNHBPA member, please fill out this form.

Email *

Date *

YYYY

What is your company name? *

Briefly describe your business. *

Owner's Name *

Address *

Mailing Address (if different from address)

City & State/Zip Code *

Email Address *

Website

Business Contact Phone Number *

Personal Cell Number

Business Owner Information

Category *

Minority-Owned Business Enterprise

Women-Owned Business Enterprise

Other:

Required

Ethnicity *

African-American

Caucasian

Asian Pacific

Hispanic

Native American

Required

Gender *

Male

Female

Other:

Business Structure *

Sole Proprietor

Partnership

Corporation

LLC

Other:

Year Established *

Product/Services *

Were you referred to GNHBPA? How did you hear about our organization? *

Privacy Notice

We will not share your information with business partners or third party organizations. We process your information to communicate with you and to provide, administer, and improve our services. If you have any privacy-related questions or concerns, please feel free to contact us at info1.gnhbpa@gmail.com.

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