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WTC Global Business Forum Delegation Interest Form
Disclaimer
Completion of this form does not guarantee acceptance. You will be contacted with additional information.
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1.
Please enter the information indicated below.
(Required.)
First and Last Name
Company
City/Town
State/Province
ZIP/Postal Code
Company Website
Email Address
Direct/Mobile Phone Number
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2.
Please indicate your primary Council affiliation:
(Required.)
Capital Region MSDC
Eastern MSDC
NYNJ MSDC
Other (please specify)
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3.
Is your MBE certification current?
(Required.)
Yes
No
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4.
List your current industry (Life sciences, Manufacturing, Food and agriculture, Innovation and technology, Higher education preferred):
(Required.)
*
5.
Revenue Class:
(Required.)
Class I (Below $1M)
Class II (Between $1M - $10M)
Class III (Between $10M-$50M)
Class IV ($50M +)
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6.
Years In Business?
(Required.)
Less than 3 years
3 years or more
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7.
Number of Full time and/or Part time Employees in addition to yourself?
(Required.)
1-2
3 or more
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8.
In 1000 characters or less, please state why you should be selected to attend.
(Required.)
Current Progress,
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