Lewistown Community Entrepreneur Club

Thank you for your interest in the Lewistown Entrepreneur Club. This is a 12-month commitment, and you are strongly encouraged to attend 9 of the 12 monthly meetings. Participation is open to all, but priority will be given to Lewistown residents, and then Fulton County residents since the discussions will focus on local needs.
Space is limited to 10 club members.

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Contact Information

First Name

Last Name

Street Address

Street Address 2

City

State

ZIP

Daytime Phone

Evening Phone

E-mail Address

Where are you in considering starting your business? Please select from one of the options below. Registrants who have been in business for 5+ years are not eligible to register

Thinking about an idea for my business

Been doing my business as a side gig

Been in business under 5 years

What kind of business are you considering starting or have started? Please indicate the field of business like food truck, retail, cleaning, home aide, online, professional services etc.

Photo Release I, the undersigned, do hereby consent to the use by The Board of Trustees of the University of Illinois (University) of my image, voice, or both described below, in (1) the video, photograph, or audio recording described below; and (2) any video, photograph, or audio recording reproduced either in whole or in part from the video, photograph or audio recording described below: regardless of whether these materials are used for fundraising, advertising, publicity, or any other purpose on behalf of either the University or its Foundation. I warrant that I have the full right and authority to grant this consent. In addition, I waive all claims to compensation or damages based on the use of my image or voice, or both, by either the University or the Foundation. I also waive any right to inspect or approve the finished photograph or video or audio recording. I understand that this consent is perpetual, that I may not revoke it, and that it is binding on me, my heirs and assigns. I warrant that I am at least 18 years of age and that I am competent in my own name insofar as this consent is concerned, or that I am the parent or legal guardian authorized to sign on behalf of a person under age 18. I further attest that I have read this consent form and fully understand its contents.

YES

Civil Rights Compliance - Participant Info

As part of our commitment to providing equal opportunities in our programming, University of Illinois Extension is required to collect and report overall statistics about the race, ethnicity, and gender of program participants. Your responses are voluntary and appreciated.

Gender

Ethnicity

Race