2023 Women & Pride WBE Intake Form

2023 Women & Pride WBE Intake Form
- Do you identify as LGBTQ+ and are the majority owner of a WBENC-Certified Women's Business Enterprise? We want to hear from you!
  
  Please complete the form below to be considered for exclusive WBENC Women & Pride news and opportunities such as WBE spotlights and any speaking and panelist opportunities that may arise.
- Name*
  
  First NameLast Name
- Pronouns
  
  She/herHe/HimThey/ThemOther
- Email*
  example@example.com
- Phone Number*
  
  Area CodePhone Number
- Title/Role*
- Ethnicity*
  
  White or CaucasianBlack or African AmericanHispanic or LatinoAsian or Asian AmericanAmerican Indian or Alaska NativeNative Hawaiian or other Pacific IslanderMiddle EasternPrefer not to answerOther
- Age Range*
  
  Under 2525-3435-4445-5455-6465 or overPrefer not to answer
- Do you identify as a member of the LGBTQ+ community?*
  
  YesNoPrefer not to answer.
- I identify as:*
  
  LesbianGayBisexualPansexualTransgenderQueerOther
- Please provide a short personal bio (3-5 sentences) *
- Please upload a high-resolution headshot *
  
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  Cancelof
- Company Name *
- Company Website*
- Company Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- What is your primary industry?*
  Based on Primary NAICS Code (as listed in WBENCLink2.0)
- Year Business Established*
- Is your company:*
  
  Majority ProductsMajority ServicesBoth Products and Services
- Are you currently WBENC-Certified and in good standing as a Women's Business Enterprise?*
  
  YesNo
- Regional Partner Organization (RPO)*
- Please provide your WBENCLink2.0 System Vendor Number. *
  To find your System Vendor Number: 1) Log into your profile in WBENCLink at www.wbenclink.org, 2) Click on your Certifications, 3) Your system vendor number is in the upper right corner
- Please select all WBENC Programs you have participated in*
  
  Chemical Industry AcceleratorWBENC Energy Executive ProgramWeIGNITEWeTHRIVEWeTHRIVE DigitalWBENCPitchWBENC Thriving with Capital OneRobert Half Accelerated Leadership Development Program (ALD)WBENC-Tuck CapstoneOther
- Are you currently Certified as an LGBTBE by the National LGBT Chamber of Commerce (NGLCC)?*
  
  YesNoOther
- Please provide a short company description (3-5 sentences) *
- Please include your company's Instagram handle *
  (N/A if you do not have one)
- Please include your company's LinkedIn handle *
  (N/A if you do not have one)
- Please upload a high-resolution web version of your company logo *
  
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- I understand that WBENC may or may not reach out for a follow up, and that completion of this form does not guarantee involvement within the Women & Pride program"*
  
  I agree
- Should be Empty: