WE 360 registration

YOUR NAME *

MS. / DR. ETC. FIRST NAME MIDDLE / INITIAL LAST NAME JR. / III / ESQ / ETC.
YOUR EMAIL *
YOUR MAILING ADDRESS *

YOUR STREET ADDRESS OR PO BOX

CITY STATE

ZIP
YOUR PHONE NUMBER *

AREA CODE PHONE NUMBER
YOUR ENTREPRENEURSHIP STATUS *

I currently own a business I have begun the process to start a business I intend to start a business
YOUR INDUSTRY (FOR WE 360 RECORDS ONLY) *

Beauty Consulting Ecommerce Education Faith-based organization Financial services & insurance Food & beverage Healthcare Hospitality Human resources & training Logistics Public speaker Real estate Retail Sales & marketing Technology
YOUR RACE (FOR WE 360 RECORDS ONLY) *

African American or black American Indian or Alaska native Asian Bi-racial / multi-racial Hispanic or Latinx Native Hawaiian or other Pacific Islander
YOUR GENDER (FOR WE 360 RECORDS ONLY) *

Female Non-binary / third gender Transgender
YOUR AGE (FOR WE 360 RECORDS ONLY) *

15-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100
I hereby give permission for YWCA Greater Charleston to post photos and/or videos of me at WE 360 workshops on YWCA Greater Charleston’s social media pages and/or materials. My typed name below will serve as my signature.
SIGNATURE *
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