MBDA CAPACITY BUILDING CERTIFICATE PROGRAM REGISTRATION

M. Gill/MBDA CAPACITY BUILDING CERTIFICATE PROGRAM REGISTRATION

Please complete this REGISTRATION in order to be considered for participation in the M. Gill/MBDA Capacity Building Certificate Program. ANSWER ALL QUESTIONS.
1. Name of Business*
2. Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
3. Type of Business (Choose One)*

ManufacturerConstructionProfessional servicesRetailExportSupplier DistributorOther
4. Please Check All Applicable Certifications*

WBE (Women-Owned Business Enterprise)SBE (Small Business Enterprise)MBE (Minority Business Enterprise)DBE (Disadvantaged Business Enterprise)Veteran Owned (Business Owned by a U.S. Veteran)None of the AboveOther Certification Not Listed Above
If Other Certification Not Listed Above is Selected – Please list here:
5.    Owner participating in the program

a. Name:  First Name*   Last Name*
b. Percent (%) Ownership in the participating businessNumber*%
c. Telephone: Area Code*   Phone Number*  Email: Email*
6. Non-Owner (Designated Participant if not Business Owner)

a. Name: First Name Last Name Position Title: Title
b. Telephone: Area Code Phone Number Email: Email
7. Annual Business Sales (Select one)*

Less than $100,000Between $100,000 – $200,000Between $200,000 - $300,000Between $300,000 - $400,000Between $400,000 - $500,000Over $500,000
Participants are required to register as an MBDA Client upon Completion of the Capacity Building Program
8. Do you agree to register as an MBDA Client to receive No-Cost Technical Assistance Services?*

YesNo
9. Do you agree to participate in the entire 9-hour course?*

YesNo
10. Official Business Owner Or Designated Participant’s Signature*

Clear
Date*

MonthDayYear
Date
Graduates of the M. Gill/MBDA Capacity Building Program will receive:

1.     A Certificate of Completion

2.     Access to Financial Investment Opportunities

3.     Access to New Contracting Opportunities

4.     Access to New Local and International resources for Business Growth

5.     Ongoing, No-Cost Technical Assistance from the M. Gill/MBDA Team

6.     Potential Matchmaking Opportunities with Business Growth Professionals & Mentors
DISCLAIMER
- Program eligibility is determined by the MBDA Business Center – Operated by M. Gill & Associates, Inc.
- I understand that applying to this program will put me in consideration for other sessions, if I'm not selected for the most current.
- A complete Registration (with all questions addressed) is required.
- If you need further information, please contact us at admin@miamimbdacenter.com or 786-515-0670.
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M. Gill/MBDA CAPACITY BUILDING CERTIFICATE PROGRAM REGISTRATION

Participants are required to register as an MBDA Client upon Completion of the Capacity Building Program