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2. Business Name*
3. Date:*
   Date:
5. Business Address*
7. City*
8. State*
9. Zip Code*
11. Contact Name*
13. Contact Phone*
14. Cell Phone*
16. Contact Email*
18. *Members are appointed to the EDC as a business, not as individuals.
22. TITLE AND POSITION DESCRIPTION OF CONTACT PERSON:
24. Contact Title
26. Position Description
30. DESCRIPTION OF BUSINESS
34. WHY DO YOU DESIRE THIS APPOINTMENT?
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38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field