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 Business NoYesRegistered 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 Membership Type *Small Business or Individual (Less than $50,000 Sales) - $100.00Emerging (1 to 5 employees) - $125.00Building (6 to 29 employees) - $250.00Scaling (30 to 99 employees) - $400.00Expanding (100 - 499 employees) - $600.00Large (500+ employees) - $1,000.00Associate 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
