Register

Please answer the following questions regarding your existing or planned business.

First Name
Last Name
Zip Code	Enter your 5 digit Zip Code. If you don't have one or don't know your zip code, enter 00000

Business Name	Leave blank if you do not have a name chosen or the business name is the same as your name.
Position	Your position or title related to this business
Address	Your physical street address (number and street) of the business. If a home based business, or the business has not started yet, use your home address.
Address Line 2	Optional. Use for additional address postal information like apt, floor, suite, etc., or a PO Box.
City
State

Please enter contact information regarding this business so that we may contact you if necessary

Primary Phone	The best phone number (with area code) to reach you during our standard business hours. Include extension if necessary.
Primary Phone Type	Type of the primary phone above
Secondary Phone	A secondary phone number to contact you, if we cannot reach you at the primary number.
Secondary Phone Type	Type of the secondary phone above

Web Site	Web site URL for the business
Business Description	Brief three to five word description of the business

Please answer the following demographic questions about yourself.

Race	Asian Black or African American North African Middle Eastern Native American/Alaska Native Native Hawaiian/Pacific Islander White Prefer not to say Other Check any that apply
Hispanic Ethnicity
Gender
LGBTQ
Disability	Do you consider yourself a person with a disability
Military Status
Branch of Service
New Hampshire Alumni Status	Community College System of NH Current UNH Student Not an Alum UNH UNH Business School (Paul, WSBE) University System of NH (PSU, KSC, GSC, etc.) Check any that apply

Business Status

Business has started

Check if you have started conducting business. Leave unchecked if you are in the planning stages and have yet to start this business. A client is “In Business” if they have: completed required registration(s) with local, state and/or Federal Government (e.g., DBA registration, get a business license, agency issued tax identifications, etc.) AND at least one of the following: has documented sales, has hired an employee or independent contractor, has acquired debt or capital to pursue business operations, or had incurred business expenses in the operation of the business.

Since this an existing business, please enter the following information.

Year Started	Year this business started
Month Started	Month this business started
Business Type	Primary category of business
Female Ownership %	% Enter the percent female ownership for this business.
Business Online	Yes If business is conducted online
Home Based Business	Yes If business is home based
8(a) Certified	Yes If you are currently 8(a) certified.

Business Organization

Legal entity of the business

Employees FT

Current Number of Full Time Employees

Employees PT

Current Number of Part Time Employees

Annual Sales $

Annual Sales $ for the most recent full business year

Are you currently exporting

Yes

How did you hear about us?

Other Event & Workshop Interests

Please check any topics you are interested in

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(eCourse) Building a Culture of Safety

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Registration

(eCourse) Building a Culture of Safety