Online registration form ....
*
= mandatory fields
Title *
Dr
Mr
Mrs
Miss
Ms
First Name *
Surname *
Email *
Mobile
Work Tel *
Choose a Password
(4 char min)
*
Confirm your Password *
Receive mail notifications of events, services & offers?
Yes
No
Ethnicity
Black : Caribbean
Black : African
Black : Other
Indian
Pakistani
Bangladeshi
Chinese
Other Asian
White British
Other
Business/Trading Name *
Business Address *
Town
Postcode *
Nature of Business
Date Established
No of Employees
1
1-5
5-10
10-20
20-40
40+
Turnover
£0 - £50k
£50k - £100k
£100k - £150k
£150k - £250k
£250k - £500k
£500k+
Where did you hear about the MBN?
Were you refered to the MBN network? If so, by who?
What support would you like from the Minority Business Network?
What level of support and assistance are you willing to offer the network?
If elected I/we agree to abide by the
terms and conditions
of membership of the MBN and observe their rules and regulations
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