Register

To register for the Aspiring Entrepreneur Program, please answer the following questions:

First Name
Last Name
Zip Code	Enter your 5 digit Zip Code. If you don't have one or don't know your zip code, enter 00000

Address	Your physical street address (number and street) of the business. If a home based business, or the business has not started yet, use your home address.
Address Line 2	Optional. Use if you need additional address postal information like apt, floor, suite, etc., or a PO box.
City
State
Primary Phone	The best phone number (with area code) to reach you.
Primary Phone Type

Please read the following, enter your Full Name, and click Continue below to indicate your acceptance.

I request business counseling services from the Florida State Minority Supplier Development Council (FSMSDC) and the COVID Response and Relief Project and its Resource Partners. I agree to cooperate should I be selected to participate in surveys designed to evaluate the services.

I permit FSMSDC or its agent the use of my name and address for surveys and information mailings regarding FSMSDC's services.

I understand that any information disclosed will be held in strict confidence. (FSMSDC will not provide your personal information to commercial entities.) I authorize FSMSDC to furnish relevant information to the assigned management counselor(s). I further understand that the counselor(s) agrees not to: 1) recommend goods or services from sources in which he/she has an interest, and 2) accept fees or commissions developing from this counseling relationship. In consideration of the counselor(s) furnishing management or technical assistance, I waive all claims against FSMSDC personnel, and that of the COVID Response and Relief Project, its Resource Partners, and host organizations, arising from this assistance.

Please enter your full name, indicating your acceptance of the above terms.

Full Name:

Date: 5/20/2024 4:01:48 AM

Aspiring Entrepreneur Program Request for Service

Aspiring Entrepreneur Program

Please read the following, enter your Full Name, and click Continue below to indicate your acceptance.