Black Design Collective Cincinnati Chapter
Name
*
First Name
Last Name
Membership Category Being Applied for
*
Professional Designer (5 or more years of experience)
Associate Designer (Less than 5 years of experience)
Affiliate Member
Student
Referred By. If you were not referred please place NA.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Website
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Instagram
Facebook
Twitter
LinkedIn
Please attach a headshot
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Please provide a brief bio for yourself
*
Tell us about your business? How long have you been in business? What do you design? Do you have an online store, brick or mortar store or other?
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Please attach a couple of pictures of your work.
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I hereby grant and authorize Black Design Collective (BDC)the right to publish the information submitted through this form on blackdesigncollective.com and social media platforms. The authorization shall continue for the duration of my Black Design Collective membership unless I revoke said authorization in writing
Yes
No
What school did you attend? What degree did you earn? If you did not attend college please place NA in the answer.
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What areas are you looking for assistance with from Black Design Collective?
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Is there anything else you would like for Black Design Collective to know about you?
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