Social Media Training Intake

Social Media Training Intake

Your answers to the following questions help us understand individual and community trends so that we may do our best work. When requested, demographic information will be shared with funders who support Hacienda CDC and would like to know who is impacted by our programs. This information is secure, confidential and never shared individually. Please complete the following information to complete your registration.
Ticket Type
Contact Information
First Name*
Middle Name
Last Name*
Address*

Street Address

Street Address Line 2

City

Zip Code
State*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Mobile Phone Number*
Please enter a valid phone number.

Business Information
Business Name, if applicable
Your business status*

I already have an established business with salesI have an idea for a business
Is your business your main source of income?

YesNo
Tell us more about your business or business idea*
Do you currently own a computer?*

YesNo

Business Information Continued...
Business Legal Name
Business Start Date

MonthDayYear
My business address is different from my home addressMy business email address is different from the email I gave earlierMy business phone number is different from the phone number I gave earlier
Business Address*

Street Address

Street Address Line 2

City

Zip Code
Business Email
example@example.com
Business Phone Number
Please enter a valid phone number.
Website link, if applicable
Social Media link, if applicable
Which industry best describes your business?*
Do you have a co-owner(s)?

YesNo
What percent of the business do you own?
What is your business' annual revenue (best estimate)?
How many employees do you currently have?

Media Release

PHOTOGRAPHY/VIDEO/TEXT/SMS

I understand that Hacienda CDC may use photos and/or video of me, which can be published in publications, direct mailings, inserts, websites, social media and other related promotional media. I hereby consent and give permission for Hacienda CDC to take photographs and / or digital video images of me and to use and publish such photographs and/or video together with any subtitle or descriptive material, including my name, which Hacienda CDC may choose, for commercials, publicity, or any other direct purpose, inserts and other related promotional means or in any other publication or way that Hacienda CDC authorizes. I waive the right to inspect or give consent to digital video images or photographs before they are published and any form of use. I also understand that I consent to text/SMS messaging for promotional and/or communication needs. I release Hacienda CDC, its officers, agents, and employees from debts, claims, and liability of any kind by suggesting or in connection with the use of photographs or video recording use of my name and the use of subtitles or descriptive material immediately after.
Media Release Agreement:*

I have read and agree to the media release
Should be Empty:

Contact Information