Registration

Please complete your registration below. All fields marked with an * are mandatory.

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  State/Province*
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• Phone Number

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  Are you currently in business? *

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  Please select Yes No
  What is your business Industry?

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  Please select Accounting & Tax Services Advertising, Design, & Marketing Agriculture Animal & Veterinary Services Architecture, Engineering, & Related Services Arts, Entertainment, & Recreation Auto Repair & Mechanic Beauty, Cosmetics & Salon Services Business Consulting & Coaching Childcare Commercial & Residential Services Construction Counseling & Therapy Distribution & Transportation of Goods Education Farming & Livestock Fine Arts, Artisan, & Craft Work Fishing & Hunting Food & Beverage Forestry Funeral & Death Care Services Information Technology Manufacturing Media & Publishing Mining, Quarry, & Utilities Nonprofit Personal Care Services Photography & Video Services Professional Services Public Relations & Communications Real Estate Recruiting & Staffing Rental & Leasing Restaurant & Bar Retail Social Assistance & Family Services Transportation Travel, Hospitality, & Tourism Warehousing Waste Management & Disposal Website Development Wellness, Healthcare, & Home Health Wholesale
  If Other, please specify:

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  Do you have a SCORE mentor?  *

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  Please select Yes No No, but please provide information
  Would you like to receive further communications from the virtual summit cosponsors? *

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  Please select Yes No

• Profile Image

  If you wish, you may upload an image from your computer that will accompany your profile and user listings within the system (.jpg or .png format, maximum file size 1MB).

  

  Choose a File

  
  Please upload only .jpeg or .png image files.
  Please select whether or not you would like to allow other users to see your LinkedIn public profile. This is a great way to continue your communications with other users beyond the site and maximize your experience.

  Allow users to view my LinkedIn profile

• TERMS

  

   

   

  The personal data you provide will be used to register you for an event. By completing this registration form, you accept the Terms & Conditions for 6Connex.
  
  In addition, 6Connex would like to introduce you to other event attendees who share your interests. If you consent, we will use the information you provide combined with information about your visit (content viewed, rooms visited, and similar data) to identify other attendees with whom you may want to interact.

  Yes, I understand that my information will be processed and shared with the aforementioned parties in order to process my registration.

  No, I do not want my information processed and shared with the aforementioned parties and understand I will not be registered.

  You must accept the Terms & Conditions.