OAKLAND'S EMERGING 100 - Entrepreneur Interest Form
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City *
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State *
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Phone Number *
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Email Address *
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Date of Birth *
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How can we help you? Please select all that apply. *
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If you wish to be identified as a member of any of the following groups, please select:
Estimated personal income over the past 12 months: *
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How did you hear about Oakland's Emerging 100? *
Name of person or organization who referred you:
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Does your business have a name? If so, write it below.
If you haven't named your business yet, just leave this blank!
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Please check your email for information on the next steps to get support for your business through Oakland's Emerging 100!
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