Member - Member Directory

Step 1:

Member Info

Company Name *

Please add your company name.

Phone *

Please add your company phone number.

Website

Email *

Please add a valid email.

Physical Address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Step 2:

Additional Info

Business Description (1600 char max) *

Please add your company description.

Directory Category *

Please select a directory category.

Full-time Employees *

Please add your number of full-time employees.

Part-time Employees *

Please add your number of part-time employees.

Owner Demographics

What is the gender of the primary business owner? *

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Owner Birthdate *

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Is the Business Veteran Owned? *

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What is your race? *

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What is your ethnicity *

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Are you disabled? *

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Are you low income? (If yes, you may qualify for additional specialized benefits and potentially a GROW Nebraska scholarship. If you are unsure, please contact us at [email protected].) *

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Business Demographics

County *

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Do you have a business plan? *

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Where you referred by a GROW Nebraska Member?

If you were referred, who referred you?

What year did your business start? *

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What do you want to gain from joining GROW Nebraska? *

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Please tell us the current avenues on how you are selling your products *

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By checking this box I consent and agree that GROW Nebraska has the right to take or use any video/photographs of me and/or my products.

What chamber are you a member of?

Do you have a Google My Business My Page? *

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Do you have a brick and mortar store? *

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What social media are you on? *

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Do you work with Center For Rural Affairs? *

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Step 3:

Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Phone *

Please add your phone number.

Email *

Please add a valid email.

Contact Preference

Phone

Address

Same as Address in Step 1

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Create Account

Password *

Please add your login password.

Step 4:

Billing Contact

Same as Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Phone *

Please add your phone number.

Email *

Please add a valid email.

Contact Preference

Phone

Address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Create Account

Password *

Please add your login password.

Back Next Submit Application Print Application

Member Application

Step 1:

Member Info

Physical Address

Step 2:

Additional Info

Step 3:

Primary Contact

Address

Create Account

Step 4:

Billing Contact

Address

Create Account

Step 5:

Membership Package

Additional Options:

Payment Option