Business Address
Please check all that apply to your business *Home base and franchise businesses are not eligible to participate in the program
Optional Information - Race/Ethnicity (Mark one or more)
Sex is defined as a term assigned at birth is defined as a term used to refer to the chromosomal, hormonal and anatomical characteristics that are used to classify an individual as female or male or intersex. What is your current sex? (Please select one):
Gender Identity is defined as a person’s internal sense of their own gender. How do you describe yourself? (Choose all that apply)
Sexual Orientation is defined as a person’s sexual, emotional, physical, or psychological attraction to other people. What do you consider yourself? (Choose all that apply):
Age (Check all that apply.)
Language (Check all that apply.)