The intent of this survey is to inspire the dialogue among members and leaders of your league. Your responses to this years survey will be useful in the development of your league's annual curriculum and related initiatives for the 2020-2021 award year.

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* 1. CONTACT INFORMATION:
Information provided in these cells will appear in the business listing.  

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* 2. PERSON COMPLETING THIS FORM:
This information is for confirmation purposes only and will not appear in the listing. 

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* 3. NATURE OF BUSINESS SERVICES/PRODUCTS: Select up to 5
Feel free to specify speciality services/products in Other

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* 4. SELECT ALL CATEGORIES THAT ACCURATELY DESCRIBE SAID BUSINESS

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* 5. LICENSES/CERTIFICATIONS RELEVANT TO BUSINESS SERVICES & PRODUCTS:
Provide full name of license/certification and issuing entity. If not applicable enter N/A in Cell #1.

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* 6. AWARDS/RECOGNITION FOR BUSINESS SERVICES & PRODUCTS:
Provide full name of award/recognition and issuing entity. If not applicable enter N/A in Cell #1.

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* 7. SERVICE AREA: Select counties where this business can and will provide services.

By submitting this form you requesting to have your business and its contact information added to the Escambia County Minority Owned Businesses & Contractors List a project of Gulf Coast Minority Chamber of Commerce, Escambia County, Florida, the City of Pensacola Office Supplier of Diversity and Bantucola. In addition, submission of  this form means you attest all information provided is up to date and accurate, your business is 51% minority and/or women owned and operated and grant the curator permission to publish all information provided. 

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