Personal Information

Please complete the entire form.

*Required

First Name*
Last Name*
Company Name
Title
Address*
City*
State* Select AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY
Zip Code*
Telephone*
Email Address*
State of Business Select Thinking of starting a business Business has been in operation for less than 1 year Business has been in operation for 1 to 3 years Business has been in operation for 3 to 5 years Business has been in operation for more than 5 years
Type of Business Select Retail Service Manufacturing Construction Finance, Insurance, Real Estate Wholesale, Distribution Other

Workshop Selection

Please select 3 (three) workshops that you would like to attend. Once completed, click 'SUBMIT'. You will be directed to the Thank You page where you will find the link to pay through PayPal. You are required to pay the registration fee in order to reserve your space at the Total Woman Business Conference. If you choose to pay by check, please make sure to mail it to the Local Development Corporation of East New York, at 80 Jamaica Ave. 3rd Floor, Brooklyn, NY 11207, by March 31st for the early bird special.

Note: If you do not pay for your class now, you will be required to pay the door registration fee of $100.

Early Bird Registration: $50 (register by April 11th)
Door Registration: $100 (April 12th - cash only)