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Registration

Please use the form below to register for the Small Business Empowerment Forum with special guests U.S. Rep. Allen West and Florida Senate President Mike Haridopolos.

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* Registrant

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* Are you currently a Member of the Alliance for Affordable Services?

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* If you are an Alliance Member, please provide your Member Number (it is 12 characters long)- NOT REQUIRED

Will any additional guests be attending the meeting with you? Please provide their names below.

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* Guest 1

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* Is Guest 1 an Alliance Member?

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* Guest 2

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* Is Guest 2 an Alliance Member?

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* Guest 3

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* Is Guest 3 an Alliance Member?

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* Do you have a question or concern that you'd like U.S. Rep. West and/or Florida Senate President Haridopolos to address at the meeting?

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