Form – Urban Specialists

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First Name:

Last Name:

Suffix:

Role/Position:

E-mail address:

Contact Phone:

Company/Organization (Please list different businesses separately):

Website:

Address:

City:

State:

Main Phone:

Fax:

May we add your business to our Power US ON Directory?YesNo

Mission Statement:

Please briefly describe your company/organization:

Do you have any upcoming events? YesNo

[group group-event]

Select a Date

Tell us more, we can add it to our Community Calendar!

[/group]

Please help us understand your business by selecting the best entity classification.

Please check all keywords that describe the work of your organization/business.advertisingagriculture/farmingartauto/transportationautomotivebusinesscommunity/social servicecomputerconstructionconsumer servicesdating/networkinge-commerceeducationelectronicsentertainmentenvironmentalfashion/beautyfinancial servicesfitnessfood and beveragegardening/landscapinggovernmenthealth/nutritionhome improvementshousing/mortgagehuman resourcesindustrial goodsjewelry/accessoriesjobs/staffinglaw/legalmediamusicphotographyplumbingreal estaterestaurants/barretail servicessales/marketingsocial mediatechnologytravelweb/internet

What are your areas of interest for collaboration with US:Business NetworkingCollaborationCommunity DevelopmentCrime & SafetyFund DevelopmentSocial PolicyStopping ViolenceTrainingVolunteersYouthOther

[group group-other]

If other, please describe:

[/group]

Would you like to add another company/organization?YesNo

[group group-org]

Company/Organization (Please list different businesses separately):

Website:

Address:

City:

State:

Main Phone:

Fax:

May we add your business to our Power US ON Directory?YesNo

Mission Statement:

Please briefly describe your company/organization:

Do you have any upcoming events?YesNo

[group group-event2]

Select a Date

Tell us more, we can add it to our Community Calendar!

[/group]

Please help us understand your business by selecting the best entity classification.

Please check all keywords that describe the work of your organization/business.advertisingagriculture/farmingartauto/transportationautomotivebusinesscomputerconstructionconsumer servicesdating/networkinge-commerceeducationelectronicsentertainmentenvironmentalfashion/beautyfinancial servicesfitnessfood and beveragegardening/landscapinggovernmenthealth/nutritionhome improvementshousing/mortgagehuman resourcesindustrial goodsjewelery/accessoriesjobs/staffinglaw/legalmediamusicphotographyplumbingreal estaterestaurants/barretail servicessales/marketingsocial mediatechnologytravelweb/internet

What are your areas of interest for collaboration with US:Business NetworkingCollaborationCommunity DevelopmentCrime & SafetyFund DevelopmentSocial PolicyStopping ViolenceTrainingVolunteersYouthOther

[group group-other2]

If other, please describe:

[/group]
[/group]

Additional Comments:

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1401 Lamar Street, Dallas, TX 75215 - Monday-Friday 9:00am-4:00pm info@urbanspecialists.org Call us: 469.458.3006 Fax: 469.458.3378

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