Registration

All fields are required unless otherwise noted.

Name:
Organization (if applicable):
Address:
City:    State:   Zip Code:
Telephone:
Email:

I am registering for the following event:
Scott County on August 21, 2008
Dickenson County on September 4, 2008
Washington County on October 23, 2008
Patrick County on November 6, 2008
Russell County on December 6, 2008

I am (check all that apply):
A business owner. Type of Business:
Interesting in starting a business
A community supporter of business

I would like to participate in a one-on-one consultation with a business advisor on one of the following topics (Optional):
How to Start and Operate A Business
Growing Your Business/Marketing Strategy
Financing/Managing Resources
Available Resources
Starting and Operating a Tourism Venture
Selling to State and Federal Government

How did you hear about the Workshop?
Newspaper
Website
Flyer
Flier in the First Bank and Trust Company Mailing
TV
Other:

OPTIONAL DEMOGRAPHIC INFORMATION

Race (Optional):
Caucasian
African-American or Black
American Indian or Alaska Native
Asian
Native Hawaiian or Pacific Islander
Other Race
Two or More Races

Are you Hispanic or Latino (Optional)?
Yes No

Gender (Optional): Male Female

Age (Optional):


Military Status (Optional):
Not Applicable
Veteran
Vietnam Veteran
Disabled Veteran