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Ethnicity White/Caucasian African American Hispanic American Asian American Native American Other Middle Eastern
Date of Birth
Languages Spoken (Besides English) Spanish Mandarin Cantonese Tagalog Vietnamese Arabic French Korean Russian German Hindi Portuguese Other
Business/Organization (If self, put self)
Business/Organization Type Small Business (Fewer than 100 Employees) Large Business (Over 100 Employees) Business Organization Advocacy Group Academic/Research Group Government
Stage of Business Idea Start-up Established
Business Size Self-employed Fewer than 10 employees 10-24 employees 25-49 employees 50-74 employees 75-100 employees
Job Title
Are You The Owner Of The Business? YesNo
Industry Agriculture and Mining Communications Consulting / Business Services Education & Youth Services Energy and Utilities Engineering Food/Beverage Healthcare, Pharmaceuticals, & Biotech Hospitality Insurance & Financial Services Manufacturing Media & Entertainment Nonprofit Other Real Estate and Construction Retail Science/Research/Development Service / Consumer Services Software & Internet Technology / Computers and Electronics Telecommunications Transportation and Storage Travel, Recreation & Leisure Wholesale & Distributors
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Would you like your voice to be heard on surveys and polls related to small business issues? YesNo
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