First and last name

Business Name

Phone *

Email *

Business Title (if applicable)

Bio (up to 200 words)

Logo (file upload)

Headshot (file upload)

Selling a product/service?

Product/Service Description

Pictures of Product/Service (file upload)

Willing to offer a raffle?

If yes, describe raffle item

Social Media Tags

IG Handle

FB Handle

Tik Tok Handle

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