First Name *
Last Name *
Email *
Phone *
Business name and products *
Address *
Industry & Companies that you would like to connect with
Do you wish to purchase the $25.00 ticket, which includes two people?YesNo
What is the event date in which you would like to attend? *
Business Website Address *
Is your business registered with the State of Indiana? (https://inbiz.in.gov) *
Do you hold any professional licenses? If so which one and what states? *
NOTE: If application is approved you will receive an invoice link to purchase a one time ticket to one networking event. Management reserves the right to place a limit on industries, in order to provide diverse membership products. Please Initial. *
