CCOC Veterans Outreach Council Information Intake Form

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CCOC Veterans Outreach Council Information Intake Form

Please complete the following information *required for consideration of business support or participation in Council initiatives.
Section 1

Personal Information
Name*

First NameLast Name
Preferred Name (if different):
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Branch of military:*

Air ForceArmyCoast GuardMarine CorpsNational GuardNavySpace Force
Section 2

Business Information (if applicable)
Do you:
Business Name:
Business Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Website:
Business Industry Type:
Brief Description of Services/Products:
Business Ownership Status:
Are you currently a member of the Clayton Chamber of Commerce:
Section 3

Thank a Vet Program Verification
Do you have a Johnston County Thank a Vet Program Card/
Upload a copy of your card here:

Cancelof
Section 4

Request for Support
What type of support are you seeking from the Veterans Outreach Council? (select all that apply)

Business mentorshipBusiness planningMarketing/promotion supportNetworking opportunitiesEducational resourcesAssistance with starting a new businessEvent participationOther
If you selected "Other," please explain what support you are seeking:
Would you like to be connected with a business mentor:
Section 5

Additional Information
Briefly describe your goals or needs related to this request:
How did you hear about this program:

Clayton Chamber of CommerceSocial MediaReferralLocal Event
Should be Empty:

CCOC Veterans Outreach Council Information Intake Form

Section 1

Section 2

Section 3

Section 4

Section 5