Equality Business Alliance Application Please enable JavaScript in your browser to complete this form.Name *FirstLastBusiness/Organization Name *Email *Business Phone *Business Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDo you want this address listed on the EBA website? *YesNoWebsite / URL *Category that best describes your business *Advertising & NewspapersArts & EntertainmentAutomotive Repair & ServiceBusiness Development & ConsultingCleaning & Janitorial ServicesCommunity Services & Affinity OrganizationsComputer & Tech ServicesCounseling & Mental HealthCustom ApparelDentistEducationEvent PlanningEyecareFinanceFitnessFloristFood & DrinkFuneral & Mortuary ServicesHealth ServicesHealth & WellnessHome Repair & ImprovementInsuranceInterior Design & OrganizersJewelryLegal ServicesMarketingMeeting & Event SpacesNurseriesPet GroomingPhotographyReal EstateRetail & CommercialSalons & SpasScreening, Security & InvestigatorsShoe RebuildersSports Teams & OrganizationsTatoo & Body PiercingTravel & LodgingWeb Design, Media, and Online ServicesOther (please describe below)If you chose "Other," please describe:Description of your business as you would like it displayed on the EBA website: *Business Logo Click or drag a file to this area to upload. Please upload a high quality PNG, JPG, or GIF of your logo to be displayed on the EBA website.Membership OptionBusiness (25+ FTE) - $200.00Small Business (Less than 25 FTE) - $100.00Non-Profit - $50.00Coupon Code Apply Referred by / Heard about the EBA from: *Payment *Submit
