E3 Associate Directory Registration

What is your full name and title?
Name of your business
Opening date for your business
Brief description of your business *
Contact number for business *
Website for this business
Email address for this business *
Contact number for you
Business motto
Please share what your signature product or service is. Include reason why consumers should consider you or why your business stands out.
Special offer or discount for E3 members and supporters. (Consumer must mention E3 to be eligible)
Would you like to be added to our E3 distribution list? *	True False
Are you interested in membership with E3? (If yes, please answer below; If no, please click submit now) *	Yes No
Please list E3 member who encouraged you to fill out this form
E3 builds aspiring entrepreneurs into leaders. What areas are you interested in receiving support with?
Is your focus more on entrepreneurial or community based initiatives
E3 works within neighborhoods to affect positive change. Please share where and how you would like to make a difference
Would you like to be contacted by E3 membership	Yes No