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Marketing Assistance Application
Please complete as much information as possible so that we can gain an understanding of your business. You can find information about the application and webisodes at

This four-part form will collect basic and contact information about the company along with basic information about current marketing strategies.

Information submitted is confidential.

Businesses selected will receive marketing assistance either in person or virtually via webinar/webcam, in exchange for having portions of the sessions recorded and produced as The Marketer™.

Submission of this form does not guarantee acceptance into the program. All those submitting the form will be notified whether they are accepted, put onto the wait list, or not chosen.

Company/Business Name *
Your answer
Your Name (first last) *
Your answer
Your phone number *
Your answer
Your email address *
Your answer
Your role with the company *
Your answer
Are you authorized to make this submission on behalf of the company? *
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