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Full Name *
Name of Business? (Put N/A if not yet started) *
State business located in *
Primary service or product industry *
Did you start this business? * Yes No
Summary of business (please keep it clear and concise) *
What is your passion in the community? *
Do you have an E3 sponsor (person who is encouraging you to join) * Yes No
Name of E3 Member or Leader
Did any other organization recommend you contact E3? (we would like to acknowledge their support)
If not, how did you hear about E3?
What are you hoping E3 is able to help you with as an entrepreneur?
Do you require guidance with marketing, fundraising or increasing sales? (please explain) *
Have you attended any E3 workshops or training? * Yes No
Please list your website, Facebook, or other business links
What are the best days and times to contact you?
What is the best email for you? *
If approved for membership when will you be ready to join? *
Anything else we need to know? (if you feel important please share)