Program Begins: September 10 and Occurs Every Thursday from 5:30 to 9:00 P.M

Program begins: September 10 and occurs every Thursday from 5:30 to 9:00 p.m.

Please complete the following information:

First Name Last Name

Business Name (if applicable)

Mailing Address City State Zip ( ) ( ) Primary Phone (daytime) Cell Phone

Email Address

Payment Information Please select your method of payment below. If you are paying with credit card, please provide the following billing information if different than above. Credit card payments only will be accepted over the phone per WSU PCI DSS policy, please call Wendy Veatch 316.978.5219 with your credit card information.

☐ Cash ☐Check ☐ Credit Card

Growing Rural Businesses –Marion Fall 2015 1 Billing Name Billing Address

City State Zip

Please fill out a separate application for each participant. Make a copy if necessary.

1. Please provide a detailed description of your proposed or existing business and your target market.

2. Position in industry (example: manufacturer, distributor, wholesaler, and retailer).

3. Intended customers (who will pay for your product/service).

4. Who will make or supply your product or service (e.g., subcontractors, in-house/home based contractors).

5. How many years of experience have you had in the field in which you plan to start or have already started your business: Growing Rural Businesses –Marion Fall 2015 2 ☐ None ☐ 1-5 years ☐ Less than 1 year ☐ 5 + years

6. How many years of experience have you had as a manager in a company you did not own:

☐ None ☐ 1-5 years ☐ Less than 1 year ☐ 5 + years

7. How many years of experience have you had managing your own business full-time:

☐ None ☐ 1-5 years ☐ Less than 1 year ☐ 5 + years

8. Why do you want to participate in the Growing Rural Businesses program?

Growing Rural Businesses –Marion Fall 2015 3