Registration Form ‹ The Southern C

Business Name

Title

Industry

Please indicate the primary industry of your business so that we may better connect you with similar businesses at the summit.

Alum

Are you a Summit alum?!

Past Presenter or Mentor?

Summit years attended

Which years have you attended?

Website

Example: https://thesouthernc.com

Instagram handle

Example: https://www.instagram.com/thesouthernc/

Sort Weight

1 = listed first

Badge Name *

How you would like your name to display

What is your age? *

How many years in business

years

Do you have more than 3 employees? *

What is your total business revenue? *

What is your household income? *

What is the highest level of education you have completed? *

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