BBN Membership Registration Form

BBN Membership Registration Form

Join the Black Business Network and unlock access to exclusive resources, mentorship, and networking opportunities.
Business Contact Information
Business Contact Name*
Enter the primary contact person for this business membership.
Business Email*
Provide a valid email address for business-related communications.
Business Phone Number*
Enter a business contact number.
Business Name*
Enter the official name of your business.
If you have a DBA (Doing Business As), please check and provide the DBA name below.

DBA Name (if applicable)
DBA Name
Business Address*
Enter the complete business address.
Business Website
Include a URL to your business website (optional).
Business Social Media Links
Include a URL to your main social media profiles (optional).
Main Point of Contact
Main Point of Contact Name
Enter the name of the main point of contact, if different from the business contact.
Main Point of Contact Phone Number
Provide a phone number for the main point of contact.
Main Point of Contact Email
Provide an email address for the main point of contact.
Same as Business Contact

Check if the main point of contact is the same as the business contact.
Business Details
Industry Select the industry that best represents your business’s primary area of operation.

Retail: Businesses that sell goods directly to consumers.Professional Services: Consulting, accounting, legal services, and other professional support services.Health: Medical services, wellness, and other healthcare-related fields.Technology: Software, IT services, hardware development, and tech solutions.Manufacturing: Production of goods and products for other businesses or consumers.Education & Training: Schools, tutoring, workshops, or any educational services.Finance & Insurance: Financial planning, accounting, and insurance services.Real estate: Property management, real estate brokerage, and related services. Hospitality & Tourism: Hotels, restaurants, event planning, and tourism services.Construction: Building, renovation, and construction services.Other
Years in Operation Select the time range that best represents how long your business has been operational.

Less than 1 year1-2 years3-5 years6-10 yearsOver 10 years
Membership Interests
What are your primary interests in joining BBN? (Select all that apply)*

Access to networking opportunities: To connect with other Black-owned businesses, mentors, and community resources. Business Development Resources: To gain tools and information to help grow and develop your business. Participation in workshops: To learn from and engage with business and industry experts. Mentorship programs: To gain guidance and insights from experienced business leaders. Community engagement: To participate in initiatives that support Black-owned businesses and community growth. Financial planning: Resources and guidance to help manage your business’s finances, including budgeting, investments, and long-term financial stability. Business resources: Access to essential tools, templates, and support to streamline business operations, including assistance with grants, marketing, and legal resources.Other
Business Directory and Additional Information
Would you like to be added to the BBN Black Business Directory?*
Choose ‘Yes’ to have your business listed in our directory for increased visibility and networking.
Special Requirements or Requests
Let us know if you have any specific needs, accommodations, or requests.
Photo Release and Agreement
By agreeing, you grant BBN permission to use photos or video recordings taken of you during events for promotional and educational purposes.
I agree to the photo release terms and the BBN Code of Conduct and Membership Policies.*

YesNo
🎁 Enter the Holiday Social Raffle!

Win exciting prizes like gift cards, wine, and free services provided by BBN members! Simply check the box below to participate.
Yes, I want to enter the raffle.No
Not a Business Owner? Partner with Us!
Are you not a business owner but interested in partnering with BBN?

Yes, I’m interested in partnering with BBN.
Signature
Type or draw your full name to complete this membership registration.*

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BBN Membership Registration Form

Business Contact Information

Main Point of Contact

Business Details

Membership Interests

Business Directory and Additional Information

Photo Release and Agreement

🎁 Enter the Holiday Social Raffle!

Not a Business Owner? Partner with Us!

Signature