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Expression of Interest to Join 1000 Black Voices                                
CONFIDENTIAL
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Email *
Select other program(s) of interest for the future *
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Where did you see 1000 Black Voices advertised? *
Title
Surname *
First name(s) *
Address *
Post code *
Email.
(Please check your spam folder for any communications). 
 *
Telephone 
Company Name (if existing): *
Incorporated *
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Website (where available)
Number of Employees excluding Founders?   *
Number of Founders/Co-founders? *
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Please describe company *
What technology are you using? Select all *
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Which markets does your business service?
In which industry are you active? Select all *
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Current stage of Business?   *
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Have you raised funding? *
If yes, how much funding have you raised?
What is your average monthly revenue?  
What are your goals for joining 1000 Black Voices?
Anything else you would like to share?
Link to Pitch (3 mins max)
Profile: If successful, we would like to hold a short summary of your professional and company profile on our system.  This Profile should highlight your professional and company achievements and be suitable for inclusion on our website, on social, in a brochure or similar and shared with our ecosystem partners. Please note that the information provided on this form will be used to create a confidential computer and manual-based file, the use of which complies with the provision of the Data Protection Act 2018. I agree that my Biographical Profile and Company details may be used internal and external to the company during and after my participation in the program. *
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Equal opportunities policy. 1000 Black Voices is accepting applications from Black founders. Do you satisfy the above *criteria? *
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Sign and Date *
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