| |
| Registration Form |
| |
| Name*: |
|
| Address*: |
|
| City/Town*: |
|
| State*: |
|
| VP Number*: |
|
| Email Address*: |
|
| Phone Number for Text Messages: |
|
| |
|
| What is the best time for you to attend a seminar: |
Weekday
Weekend
Other
|
| |
|
| Have you set aside money to start a business: |
Yes
No
Other (Other Please Specify)
|
| |
|
| Do you have a business plan: |
Yes
No
Other (Other Please Specify)
|
| |
|
| Do you currently own a business: |
If YES, what kind of business?
If NO, what kind of business are you interested in starting?
|
| |
|
| Are you presently working: |
If YES, what kind of job?
If NO, what kind of work have you done?
|
| |
|
| How can this seminar best help you: |
|
| |
|
| Do you consider yourself: |
Other (Other Please Specify)
|
| |
|
| Do you prefer communication in: |
Other (Other Please Specify)
|
| |
|
| Are you currently receiving SSI or any other government sponsored services?: |
Yes
No |
| |
|
| Do you have a DARS Counselor?: |
No
Yes
- If Yes what is your counselor Contact Name, Number, Location?
|
| |
|
| |
|