RM_StatsASANDC Registration & Intake Form Required fields are indicated with a red * asterisk. Email *Enter email again *Contact Information First Name *Middle NameLast Name *Home Phone *Mobile PhonePreferred Contact Method *Select an optionHome PhoneMobile PhoneSMS Text MessageEmailHome Address Address Line 1 * Address Line 2 City * State or Region Alabama Alaska Arizona Arkansas Armed Forces America Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State or Region * Country Zip * Business Information Business Type * Sole Proprietor Partnership Independent Contractor Eligible Self-Employed Individual Do you have a LEGAL Business Name? *Select an optionYesNo(Enter 'Not Applicable', if you do not have a business name.)Business Name *Do you have an Employer ID Number? *Select an optionYesNoBusiness PhoneBusiness EmailLegal Business Address Address Line 1 Address Line 2 City State or Region Alabama Alaska Arizona Arkansas Armed Forces America Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State or Region Country Zip Business WebsitePrimary Business Contact Person *Business Partner Name *Employer Identification Number (EIN) *Business TIN /SSN *Business Operation Years *Select an optionUp to 12 months13 months to 5 years6 years to 10 years11 years or moreDate of Operation *Average Monthly Payroll *Select an option0 - $5000$5001 - $10000$10001 - $25000$25001 - $50000$50001 - $100000$100001+Number of Employees *Select an option0 - 56 - 5051 - 200201 - 500Over 500Background Information Birth Date *Gender *Select an optionMaleFemaleTransgenderOtherRace * Black or African American White American Indian or Alaskan Native Native Hawaiian or Other Pacific Islander Asian Asian (Hmong) Asian (Laotian) Asian (Vietnamese) OtherEthnicity * Not-Hispanic, Latino, or Spanish origin Hispanic, Latino, or Spanish origin Mexican, Mexican American, Chicano Puerto Rican Cuban OtherMarital Status *Select an optionMarriedSingleDivorcedWidowSeparatedDecline to answerVeteran Status *Select an optionVeteranNot a VeteranDecline to answerEducation Completed *Select an optionHigh School/GEDAssociate DegreeSome CollegeBachelor's DegreeGraduate DegreeTechnical CertificateBusiness Partner's Birth DateBusiness Partner's GenderSelect an optionMaleFemaleTransgenderOtherBusiness Partner's Race Black or African American White White American Indian or Alaskan Native Native Hawaiian or Other Pacific Islander Asian Asian (Hmong) Asian (Laotian) Asian (Vietnamese) OtherBusiness Partner's Ethnicity Not-Hispanic, Latino, or Spanish origin Hispanic, Latino, or Spanish origin Mexican, Mexican American, Chicano Puerto Rican Cuban OtherBusiness Partner's Marital StatusSelect an optionMarriedSingleDivorcedWidowSeparatedDecline to answerBusiness Partner's Veteran StatusSelect an optionVeteranNot a VeteranDecline to answerBusiness Partner's Education CompletedSelect an optionHigh School/GEDAssociate DegreeSome CollegeBachelor's DegreeGraduate DegreeTechnical CertificateWorkshops This registration form is limited to one submission only. Make sure that you have selected all of the workshops that you would like to attend below. If you need to update your workshop attendance after submitting this form, please contact Jennifer Smith at info@aurorastanthony.org. Workshop 1:Are You Ready to Get it Started? What is your market and industry? This workshop will cover initial steps to organizing and registering your business. It will also cover industry research that addresses standards, trends, sales, and growth. You will learn how SIC and NASIC codes work. Key to success of any business is its marketing strategies, but often it is forgotten in the planning of a startup. Identification of your niche market and strategies to get your product to market. Choose a Date - Workshop 1 * Saturday - March 11, 2023 I am not attending Workshop #1. Workshop 2:So, You Thought You Had a Plan. Now, let’s get one! This workshop will look at the benefits of a business plan, including ways to fund your business through financial institutions or private investors. A business plan is essential for every company’s success. You will understand the purpose of and process for writing a business plan that will serve you well – now and in the future! Choose a Date - Workshop 2 * Saturday - March 18, 2023 I am not attending Workshop #2. Workshop 3: Show Me the Money! This workshop will consist of diverse ways of money sourcing, financial planning, and tools for business management. A guest speaker will present on how to save and prevent losing money and on how to get organize. Choose a Date - Workshop 3 * Saturday - March 25, 2023 I am not attending Workshop #3. Business Coaching We offer Business Coaching: Business coaching is a relationship/partnership between a coach and entrepreneur seeking to maximize and optimize their business opportunity for the greatest success. Coaching instills confidence of the entrepreneur to realize their vision for their business. It supports the company values and culture the entrepreneur established within their business. Coaching relationships work to clarify and establishes accountability for the business owner. Cost per hour: $50.00 Interested in Business Coaching? *Select an optionYesNoWhat is your primary reason for completing this intake? * Business Plan Funding Technical Assistance Capital Workshops OtherWhat are the challenges that your business is currently facing? *By submitting this form, I agree that I have read the Privacy Policy and consent to the given information being used by ASANDC to contact me about workshops and events. Note: It looks like JavaScript is disabled in your browser. Some elements of this form may require JavaScript to work properly. If you have trouble submitting the form, try enabling JavaScript momentarily and resubmit. 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