Tribal Enterprise Participation Form

• Please provide the following contact information:

              Name 
             Title 
      Organization 
    Street Address 
   Address (cont.) 
              City 
    State/Province 
   Zip/Postal Code 
           Country 
        Work Phone 
               FAX 
            E-mail 
               URL 
  

   
  

• Does your company have any certifications? (Please check all that apply):

  SBA         8a          SDB         HUBZone   
  Other       Buy Indian  

• If you checked "Other," please list your other certifications.

  
  

• What type of business do you have? (Select all that apply):

  High Tech               Manufacturing           Agriculture/Livestock   Insurance             
  Transportation          Forestry                Tourism                 Construction          
  Finance                 Real Estate             Public Utilites         Gaming                
  Research & Development  Natural Resources       Wholesale Trade         Fisheries             
  Service/Retail          Other                   

• If you checked other, please define:

  
  

• What are your major products or services?

  
  

• Where is your business located?

  On a Reservation Off of a Reservation In a Rural region In an Urbanized region
  

• Are you a member of NIBA?

  Yes No
  

• Is your business women owned?

  Yes No
  

• How many employees do you have?

  
  

• How many tribal members are currently employed at your business?

  
  

• How many other American Indian or Alaskan Native, non-tribal members are employed with your business?

  
  
  

• Would you like to be listed in NIBA's Indian Business Database? This database will be available via the website to potential contracting companies, Federal agencies, and other individuals.

  Yes No
  
  

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Copyright � 2002 [National Indian Business Association]. All rights reserved.
Revised: 05/12/05