REGISTRATION FORM     Last Name                               First Name                               Middle Name                            Registered Business                             Name 1)                                             2)           Type of Business       Ownership                            Capitalization                           Current Address                     State                           Country                                    Business Address                    Home Number                            Office Number                            E-mail Address                         URL         Nature of Business            Major Activity    Minor Activity   Principal Products                   Minor Products                        Number of Employees       Target Market                         Age Group                               Remarks                                  Action                                              (Note: All Fields in WHITE are required.)