Program Interest Form

Personal Information

First Name

Last Name

Phone *

Email *

Preferred Language (English / French)

Business Address

City

Province

Business Information

Business Name

Description of Your Business

Website

Social Media Handle

Industry / Sector

Business Type

Years in Business

Business Stage

Entrepreneurship Experience

New (0–2 years)

Intermediate (2–5 years)

Experience (5+ years)

Number of Employees

Revenue Level (Annualized) for 2024

Revenue Level (Annualized) for 2025 (Year to date - YTD)

What is your primary goal for joining our programs?

How Did You Hear About CBCC?

Privacy Statement

The Canadian Black Chamber of Commerce (CBCC) respects your privacy. The information collected in this form will be used only to provide you with updates, resources, and opportunities related to CBCC programs and services. Your data will not be shared with third parties without your consent. You may unsubscribe at any time.

I identify as a member of the Black community or an ally supporting Black business excellence (optional acknowledgment)

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