Black Business Membership Application Please enable JavaScript in your browser to complete this form.Name *FirstLastBusiness Name *AddressAddress Line 1Address Line 2CityNebraskaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Contact Cell Phone *Business PhoneRegistered as a Black-owned BusinessNoYesRegistered as a Black-owned BusinessOmaha Public SchoolsCity of OmahaState of NebraskaBusiness Category *AccountingAttorneyAutomotive DetailingAutomotive Repair ServicesAutomotive SalesAwards and RecognitionBarber ShopBeauty SalonBeauty Supply StoreBlack Business GuideBookstoreBuilding Design and DraftingCall Center and TelecommunicationsCapital ManagementCareersCarpet CleaningCateringChild CareCleaning ServicesCoffeeCommunityCommunity FeaturesCommunity NewsConstructionConsultingContractorCounselingCOVID-19Dance StudioDeliveryDentistDessertsDevelopmental ServicesEducationElectricianEntertainmentEvent CenterEvent PlanningFinancial ServicesFitnessFlooringFloristFood TruckFuneral ServicesGrocery StoreHealth and WellnessHome Health CareIce CreameryInsuranceLawn CareMakeupManufacturingMarketing/AdvertisingMartial ArtsMediaMoving CompanyNail SalonNewsOnline LearningPainting ServicesPast EventsPersonal Chef ServicesPhotographyPhysicianPopcornPrintingProperty ManagementPublishingReal EstateRecord LabelRestaurantsRetailSecuritySkin CareSound and Lighting Set UpTax PreparationTechnologyTransportationTravelTree ServicesVideographyWeb DesignWireless ProviderOtherPlease select all that applies.Other Business Catergory *Brief Description of Your Business *Years in Business *Number of Employees *Annual Sales VolumesExample: $125,000Number of LocationsGoal(s) for your business in 2022What would be most helpful in order for your business to grow and create jobs in 2022?Annual Membership Type *Individual - $ 75.00Small Business (Less than $50,000 Sales) - $ 100.00Emerging ($100K to $249K in Sales) - $ 125.00Medium ($250K to $499K in Sales) - $ 250.00Large ($500K to $999K in Sales) - $ 400.00Million+ ($1 Million or More) - $ 600.00Associate Small Non-Profit (Less than $500K) - $ 150.00Associate Non-Profit ($500K or More) - $ 250.00Corporate Sponsor - $ 2,500.00Strategic Sponsor - $ 5,000.00Total Investment for the Membership$ 0.00Enter Payment Details *CardName on CardBilling Address must match registration address.Submit
