City of Boston: Small Business Roundtable Registration

Thank you for your interest in attending a City of Boston Small Business Roundtable!

The City of Boston would like your support and expertise in understanding the needs of small business owners throughout the city. Findings from the registration form and the roundtable conversations will be used to inform future support and initiatives targeting small businesses in Boston. After filling out the form below and indicating interest in attending, you will receive a confirmation email if you have been placed into a roundtable.

Please take a few minutes to complete the questions below which are a mix of mandatory and optional questions. For questions, contact Lynn Wahlquist at register@nextstreet.com; 617-318-6511. Thank you for your support!

1. Please provide us with the following contact information:

First Name of Attendee *This question is required.

Last Name of Attendee *This question is required.

Formal Title of Participant *This question is required.

Company/Organization *This question is required.

Street Address 1 *This question is required.

Street Address 2

City *This question is required.

State *This question is required.

Postal Code *This question is required.

Country

Email Address *This question is required. This question requires a valid email address.

Phone Number *This question is required. This question requires a valid number format.

Fax Number This question requires a valid number format.

Secondary Phone/Cell Phone *This question is required. This question requires a valid number format.

Website

2. Please select the sessions that you are available to attend (you can choose multiple options).
[Note: You will receive an email confirming the date and time of your session once you have been placed into a roundtable.] *This question is required.

Monday, June 1st (4:00-6:30)
Tuesday, June 2nd (9:30-12:00)
Thursday, June 18th (8:30-11:00)

3. How were you informed about the City of Boston roundtables? Please be as specific as possible. *This question is required.

Next Street Financial
City of Boston
Center for Women & Enterprise (CWE)
Boston Main Streets Foundation (BMSF)
Boston City Council
Other Please enter an 'other' value for this selection.

4. Which of the following classifications does your business fall into? (Check all that apply.) *This question is required.

B2B (business to business)
B2C (business to consumer)

5. Please identify the general category under which your business falls. *This question is required.

Please enter an 'other' value for this selection. * This question is required.

6. Please indicate your 2014 revenue range. *This question is required.

7. How would you describe your business stage? *This question is required.

Please enter an 'other' value for this selection. * This question is required.

8. Please check all that apply to your business: *This question is required.

Female-owned (WBE)
Certified WBE
Minority-owned (American Indian or Alaska Native, Asian, Black or African American, Hispanic/Latino, Native Hawaiian or Other Pacific Islander)
Certified MBE
Certified DBE
People with Disabilities-owned (PWD)

Disability-owned Business Enterprise (DOBE)
Veteran-owned (VBE)
Historically Underutilized Business (HUB)
Gay Lesbian Bi-Sexual Transgender (GLBT)
Immigrant-owned
Small Business Enterprise (SBE)

9. Please select the business owner(s) race/ethnicity.
(OPTIONAL)

Please enter an 'other' value for this selection. * This question is required.

The following questions are optional.

10. Please describe your business' product/services.

11. How many locations does your business have? This question requires a valid number format.

If your business have more than one location, please list them each below:

12. What is the highest degree or level of school that the owner of your buinesses has completed?

13. Please identify the legal form of your company/organization:

Please enter an 'other' value for this selection.

14. In what geographic markets do you currently sell your product(s)? Please be as detailed as possible, and include all geographic markets.

15. If your firm's product/services are linked to NAICS or SIC codes, please enter them below. Visit http://www.naics.com/sic-codes-industry-drilldown/ for more information.

16. How many years has your business been continuously operating? This question requires a valid number format.

17. How many full-time (30+ hour/week) employees do you currently have? This question requires a valid number format.

18. How many part-time employees (<30 hour/week) do you currently have? This question requires a valid number format.