BBI Course/Workshop Registration

Bronner Business Institute
Youth Enterprise Academy

COURSE/WORKSHOP
REGISTRATION FORM

SECTION I. CONTACT INFORMATION
Prefix: Mr. Ms.
First Name: Middle Initial
Last Name: Suffix
School Name:
Grade Level : (in Fall 2019)
Home Address:
City: State:
Country: Zip
Home Phone: ( ) -
Mobile Phone: ( ) -
Email::
School Address:
City: State:
Country: Zip
Church:
Parent(s)/Guardian(s):
Mr. Ms.
Mr. Ms.
Mobile Phone: ( ) -
Parent Email Address(es):
Email:
Email:
Mobile Phone: ( ) -

Select the course or workshop you wish to enroll in. 

SECTION II. PERSONAL PROFILE
1.Gender: Male Female 2.  Date of Birth: mm/dd/yyyy
3. What is your ethnic background?

Other:
4. Does anyone in your immediate family own and operate a business?
Yes No If yes, what kind of business?
Do you work or help out in this business? Yes
No
5. Do you have computer knowledge in the following? (Check all that apply)
MS Windows MacOS Linux MS Word MS Excel
MS PowerPoint HTML/Web Design iOS Android
  Do you own any computing devices? Laptop Tablet Desktop PC
6. What do you hope to gain from the summer business boot camp?
SECTION III. YOUR BUSINESS IDEA
1. Do you have a specific business in mind? Yes No
Business Description:
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