Equality Means Business Membership Form

By Becoming a Member of Equality Means Business:
- You will join the ranks of other business leaders who respect and value the diversity of their customers and employees
- Your business name will be featured in an online directory identifying businesses that support diversity to improve Virginia's reputation as a welcoming place to live, work, and visit
- You will receive marketing material that can be used in communications, PR, recruiting, etc.
Name of Business *
Your answer
Estimated Number of Employees *
Your answer
Printed name of Authorized Representative *
Your answer
Title of Authorized Representative Listed Above *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Email Address *
Your answer
Phone *
Please use the format XXX-XXX-XXXX
Your answer
Website URL
Your answer
OUR PLEDGE: My business is open to all potential customers and clients and will not turn away service to anyone based upon their actual or perceived sexual orientation or gender identity. My business will never deny or restrict employment to anyone based upon their actual or perceived sexual orientation or gender identity. *
Required
Date of Agreement *
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service