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New Member Questionnaire

Company Name:
Phone:
() -
Assigned Ambassador's Name:
Date of Visit:
Primary Contact:
Please enter in Last Name, First Name
Title:
Email (Primary Contact):
Secondary Contact:
Secondary Contact Title:
Email (Secondary Contact):
Name of person who handles your marketing:
Marketing Rep Email:
Number of Employees:
Full-time:
Part-time:
Seasonal Employees (include date range of seasonal employment):
Year business opened:
Why did you join the HCC?:
What resources or programs are you interested in?:
Is there something specific that the HCC can do for your business?:
Who is your target customer or client?:
Is there a specific HCC Member or Member Business that you would like the HCC to introduce to you? (We will do our best to facilitate an introduction.):
Please mark any that apply to your business:
I received my HCC plaque in the mail:
I am receiving HCC Newsletter and Event emails:
I am interested in having a Ribbon Cutting Ceremony for my Grand Opening:
I completed my HCC Online Member Directory Profile Page:
I would like to introduce my company to the HCC Members by being an Event Sponsor:
I would like to introduce my company to the HCC Members by using a low-cost advertising tool (as little as $50):
I follow the HCC using:
I am interested in joining the HDA (Henderson Development Association):
I am interested in contributing to IMPAC (Issues Mobilization Political Action Committee):
I am interested in these topics and/or presenters:
Questions or comments:

Join HDA here

Contribute to IMPAC here

Request a Ribbon Cutting here