Please provide your contact information below. Contact information will not be shared externally of the NC Rural Center and NC Small Business Coalition.

* First Name:
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* Last Name:
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* Email:
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* Are you and entrepreneur or small business owner?
What is the name of your business/organization:
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* What county is your business/organization based in? *(if not in NC, please respond with the county and state of your business)
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Please provide your address information below. This information will be used to accurately identify your local, state, and federal policymakers regarding relevant small business legislation and engagement opportunities.

Home Address:
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Home City:
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Home State Acronym (e.g. NC):
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Home Postal Code:
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Leading with diversity, equity, and inclusion is a core value of the NC Rural Center. The questions below are optional, but will help us better understand if we're meeting our commitment to building a more inclusive and equitable community.

Gender:
Race:
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Are you of Hispanic/Latino/Spanish origin?