Roundtable Feedback Form

Personal Information

Are you female?
Are you a minority?
Are you a veteran?
Are you disabled?

Business Information

Are you a certified MBE Edge Disadvantaged Business?

If you would like to share your social media accounts, please list them below

For Current Business Owners

All About You!

Do you have an event you would like Secretary LaRose to attend?
Would you like to be part of our Diversity Inclusion Coalition?
Are you interested in a PowerPoint presentation by our staff on the following?

Voter Information

Are you registered to vote?
Have you moved since the last election?
Do you have a child or family member in the military?
Do you have a family member that is a veteran?