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Membership Application
Name/Company Name
*
Email
*
Physical Address
*
Phone Number
*
Fax Number
Contact Person / Title
*
Ethnicity
*
African-American
Asian
Caucasian
Hispanic
Native American
Other
Summary of products/services your business offers
*
Directory classification for business
*
Web address
Date business was established
*
# of permanent/full-time employment
*
Number of locations in Austin
*
Gross sales for fiscal year
*
Majority of business ownership
*
Minority
Non-Minority
Not Applicable
Type of Business
*
Corporate
Small Business
Non-Profit/Government Agency
Individual
Student
Would you like to be a volunteer
*
Yes
No
Membership Level Desired
*
Corporate One Star
Corporate Two Star
Corporate Three Star
Corporate Four Star
Small Business One Star
Small Business Two Star
Small Business Three Star
Small Business Four Star
Non-Profit / Government Agency
Individual
Student
How do you intend to pay
Online through PayPal
Need invoice
Check
Credit Card
Will call to arrange
