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* 1. Full Name 

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* 2. Business Name

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* 3. Gender

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* 4. Email Address

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* 5. Telephone Number

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* 6. Home Address

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* 7. Business Address (if different from home)

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* 8. Residency status

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* 9. Are you the business owner?

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* 10. Business Type

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* 11. How long have you been in business?

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* 12. Business' Annual revenue in the last full year?

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* 13. Number of Employees (if you have employees). Please indicate the number of Full Time and/or Part Time employees.

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* 14. Please provide a brief business description.

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* 15. What is your product or Service?

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* 16. What are your 3 biggest challenges?

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* 17. What do you want your business to look like in the next 3 years?

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* 18. What are you hoping to achieve by attending these peer groups?

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* 19. Do you have a preference on the advisor you are placed with?

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