Engagement Inquiry Form

ENGAGEMENT INTEREST FORM

Thank you for your interest in sharing your expertise, providing resources and supporting the Gwinnett Entrepreneur Center and its members.

Please complete the top portion and the section marked "ALL INTEREST" and then use the sectioned drop downs to complete the parts of this form that align best with the opportunities you are interested in, either:
- FOR THOSE INTERESTED IN SPEAKING/PRESENTIER OPPORTUNITES
- FOR THOSE INTERESTED IN GETTING ENGAGED IN OTHER WAYS
Thank you again for your interest.
Name *

First Name Last Name
Company Name
Your Title *
Website
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Email *
Phone *

Area Code Phone Number

FOR THOSE INTERESTED IN GETTING ENGAGED IN OTHER WAYS
Please indicate the opportunities that interest you:

Mentoring an entrepreneur Facilitating round table discussions Sponsoring a program or event Sponsoring a deserving entrepreneur Donating supplies or products to the Center Offer a discount for our products /services I'm not sure, let's discuss how I can best get plugged in.
Please elaborate a bit on what you'd like to offer
Ex. Item, dollar amount, quantity.