Certification Registration Form

Please select which Organization you will be attending the Certification event with*

VenprendedorasHaitian American Chamber of CommerceHispanic Heritage Chamber of Commerce

Have you already purchased your ticket? Your ticket must be purchased in addition to completing this form to attend this event. You can purchase your ticket here: www.grants4uinc.org/paid-offerings*

YesNo

This is an important watch to prepare for your certification. Thank you for watching.

Business Owner Name*

First NameLast Name

Gender*

MaleFemale

Are you a Veteran?*

YesNo

Personal Phone Number*

Residential Zip Code*

What is the zip code of your residential address?

Business Name*

Is this business a DBA or Fictitious Name?*

YesNo

Business EIN*

Business Zip Code*

What is the zip code of your registered business address?

Years In Business*

Business Phone Number*

Business E-mail*

Business Website*

Business Social Media Handles

How many owners does your company have?*

If just yourself, put 1

Note:

All owners must purchase their own ticket and complete this form. Majority owner must be present at the event. Discounted tickets available if a company has 3 or more owners. Please email us at info@grants4uinc.org to inquire about the group rates.

What products and/or services does your business offer? *

This will be used to determine appropriate NAICS codes in Florida's procurement system

Will you be available before the event date to set aside 10 - minutes for a one-on-one call or group Zoom with Grants 4 U staff to go over the required documents?*

YesNo

Which certificate will you be obtaining? Please select all that apply. Please note, your ownership must be 51% or more in each qualifying category.*

Women Business EnterpriseMinority Business EnterpriseVeteran Business Enterprise

Will you need any assistance gathering any of the above listed documents? Please explain in detail. If no put n/a

Will you need translation services? Please select if applicable:

SpanishHaitian CreoleAmerican Sign LanguageOther

Will you need to utilize one of our laptops during the session?*

No, I have a reliable laptop that I will bring to the brunch.Yes, I need to utilize a laptop during the brunch

Do you require any accessibility accommodations to fully participate in this activity or event? Please discuss..

ex. vision (front seating), low table seating vs high top, wheelchair access, etc..)

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Photo/Video Release Acknowledgement

Sip and Submit is a public event that will have photography and videography throughout. I, the undersigned, hereby grant Grants 4 U Inc the absolute right and permission to use my photograph(s)/video(s) in any manner or media, including, but not limited to, the following purposes:

Educational materials
Publications
Advertising and promotional materials
Social media platforms
Websites
Press releases

I understand this is a public event and no monetary compensation will be provided. I release Grants 4 U Inc from any claims relating to the use of these materials. I grant Grants 4 U Inc the following rights:

The right to edit, alter, copy, or distribute the photograph(s)/video(s) for any lawful purpose. The right to use my name in connection with the photograph(s)/video(s) if they choose.

I hereby release and discharge Grants 4 U Inc, its employees, agents, and representatives from any and all claims, demands, or causes of action that I may have now or in the future for defamation, invasion of privacy, or violation of the right of publicity or any other right arising out of or relating to the use of the photograph(s)/video(s).

By signing below, I acknowledge that I have read and understood this Permission to Use Photo Release Form and agree to the terms and conditions stated above.

Date*

Date

Signature*

Please upload your company logo.

This will be used when drafting your letters of attestation

Grants 4 U - Certification Series

This form may take approximately 10 minutes to complete.

Miami-Dade County and Broward County Entrepreneurs, join us during our certification series in partnership with your local entrepreneurial support organization or chamber of commerce!

Visit the link below for the video script in Spanish

Visit the link below for the video script in Haitian Creole

Small Business Information