Individual Registration

Please enter information in the form below to process registration for

AI Workshop - None Clients of FLWBC

Thursday, October 17th, 2024 @ 11:30am

Click the download link below to download The SBA 641 Form
(if you need to submit one with your registration)

NOTE: Fields Mark with an * are required.

DOWNLOAD SBA641

First Name *

Last Name *

Organization / Business

Address *

City *

State

Zip *

Phone *

Email *

Business Name *

Are You The Business Owner? *

Sex *

Race *

Are you disabled? *

Are you a veteran? *

Did you Submit an SBA 641 Form within the last 6 months *

Please attached your signed SBA 641 Form (Download 641 Form Above)

Policy *

I acknowledge and agree.There are no Refunds for events.I give permission to The Florida Women's Business Center and/or The Center for Technology, Enterprise & Development, Inc. to publish, copyright, and use pictures of me gathered at events in print and electronic formats such as publications, videos, projects, websites, flyers and social media posts that help advance any economic development initiatives via the Center. I understand that my picture or story may be published in any of these media without restriction. I understand that I will not receive payment or other compensation for use of my story or photos.

Payment Information

Registration Cost

Payment Method

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*