Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
State of Prospective Business
*
ALABAMA AL
ALASKA AK
ARIZONA AZ
ARKANSAS AR
CALIFORNIA CA
COLORADO CO
CONNECTICUT CT
DELAWARE DE
FLORIDA FL
GEORGIA GA
HAWAII HI
IDAHO ID
ILLINOIS IL
INDIANA IN
IOWA IA
KANSAS KS
KENTUCKY KY
LOUISIANA LA
MAINE ME
MARYLAND MD
MASSACHUSETTS MA
MICHIGAN MI
MINNESOTA MN
MISSISSIPPI MS
MISSOURI MO
MONTANA MT
NEBRASKA NE
NEVADA NV
NEW HAMPSHIRE NH
NEW JERSEY NJ
NEW MEXICO NM
NEW YORK NY
NORTH CAROLINA NC
NORTH DAKOTA ND
OHIO OH
OKLAHOMA OK
OREGON OR
PENNSYLVANIA PA
RHODE ISLAND RI
SOUTH CAROLINA SC
SOUTH DAKOTA SD
TENNESSEE TN
TEXAS TX
UTAH UT
VERMONT VT
VIRGINIA VA
WASHINGTON WA
WEST VIRGINIA WV
WISCONSIN WI
WYOMING WY
Prospective Business Industry
*
Accountants
Advertising/Public Relations
Aerospace, Defense Contractors
Agribusiness
Agricultural Services & Products
Agriculture
Air Transport
Air Transport Unions
Airlines
Alcoholic Beverages
Alternative Energy Production & Services
Architectural Services
Attorneys/Law Firms
Auto Dealers
Auto Dealers, Japanese
Auto Manufacturers
Automotive
Banking, Mortgage
Banks, Commercial
Banks, Savings & Loans
Bars & Restaurants
Beer, Wine & Liquor
Books, Magazines & Newspapers
Broadcasters, Radio/TV
Builders/General Contractors
Builders/Residential
Building Materials & Equipment
Building Trade Unions
Business Associations
Business Services
Cable & Satellite TV Production & Distribution
Candidate Committees
Candidate Committees, Democratic
Candidate Committees, Republican
Car Dealers
Car Dealers, Imports
Car Manufacturers
Casinos / Gambling
Cattle Ranchers/Livestock
Chemical & Related Manufacturing
Chiropractors
Civil Servants/Public Officials
Clergy & Religious Organizations
Clothing Manufacturing
Coal Mining
Colleges, Universities & Schools
Commercial Banks
Commercial TV & Radio Stations
Communications/Electronics
Computer Software
Conservative/Republican
Construction
Construction Services
Construction Unions
Credit Unions
Crop Production & Basic Processing
Cruise Lines
Cruise Ships & Lines
Dairy
Defense
Defense Aerospace
Defense Electronics
Defense/Foreign Policy Advocates
Democratic Candidate Committees
Democratic Leadership PACs
Democratic/Liberal
Dentists
Doctors & Other Health Professionals
Drug Manufacturers
Education
Electric Utilities
Electronics Manufacturing & Equipment
Electronics, Defense Contractors
Energy & Natural Resources
Entertainment Industry
Environment
Farm Bureaus
Farming
Finance / Credit Companies
Finance, Insurance & Real Estate
Food & Beverage
Food Processing & Sales
Food Products Manufacturing
Food Stores
For-profit Education
For-profit Prisons
Foreign & Defense Policy
Forestry & Forest Products
Foundations, Philanthropists & Non-Profits
Funeral Services
General Contractors
Government Employee Unions
Government Employees
Gun Control
Gun Rights
Health
Health Professionals
Health Services/HMOs
Hedge Funds
HMOs & Health Care Services
Home Builders
Hospitals & Nursing Homes
Hotels, Motels & Tourism
Health
Health Professionals
Health Services/HMOs
Hedge Funds
HMOs & Health Care Services
Home Builders
Hospitals & Nursing Homes
Hotels, Motels & Tourism
Human Rights
Ideological/Single-Issue
Indian Gaming
Industrial Unions
Insurance
Internet
Israel Policy
Labor
Lawyers & Lobbyists
Lawyers / Law Firms
Leadership PACs
Liberal/Democratic
Liquor, Wine & Beer
Livestock
Lobbyists
Lodging / Tourism
Logging, Timber & Paper Mills
Manufacturing, Misc
Marine Transport
Meat processing & products
Medical Supplies
Mining
Misc Business
Misc Finance
Misc Manufacturing & Distributing
Misc Unions
Miscellaneous Defense
Miscellaneous Services
Mortgage Bankers & Brokers
Motion Picture Production & Distribution
Music Production
Natural Gas Pipelines
Newspaper, Magazine & Book Publishing
Non-profits, Foundations & Philanthropists
Nurses
Nursing Homes/Hospitals
Nutritional & Dietary Supplements
Oil & Gas
Payday Lenders
Pharmaceutical Manufacturing
Pharmaceuticals / Health Products
Phone Companies
Physicians & Other Health Professionals
Postal Unions
Poultry & Eggs
Power Utilities
Printing & Publishing
Private Equity & Investment Firms
Pro-Israel
Professional Sports, Sports Arenas & Related Equipment & Services
Progressive/Democratic
Public Employees
Public Sector Unions
Publishing & Printing
Radio/TV Stations
Railroads
Real Estate
Record Companies/Singers
Recorded Music & Music Production
Recreation / Live Entertainment
Religious Organizations/Clergy
Republican Candidate Committees
Republican Leadership PACs
Republican/Conservative
Residential Construction
Restaurants & Drinking Establishments
Retail Sales
Retired
Savings & Loans
Schools/Education
Sea Transport
Securities & Investment
Special Trade Contractors
Sports, Professional
Steel Production
Stock Brokers/Investment Industry
Student Loan Companies
Sugar Cane & Sugar Beets
Teachers Unions
Teachers/Education
Telecom Services & Equipment
Telephone Utilities
Textiles
Timber, Logging & Paper Mills
Tobacco
Transportation
Transportation Unions
Trash Collection/Waste Management
Trucking
TV / Movies / Music
TV Production
Unions
Unions, Airline
Unions, Building Trades
Unions, Industrial
Unions, Misc
Unions, Public Sector
Unions, Teacher
Unions, Transportation
Universities, Colleges & Schools
Vegetables & Fruits
Venture Capital
Waste Management
Wine, Beer & Liquor
Women's Issues
What Have You Accomplished to Date?
*
Select All That Apply
Selected Business Name
Filed Articles of Organization
Developed Website
Trademarked
Patented
Copyrighted
None of the Above
What resources have you consulted to Date?
*
Select All That Apply
Consulted an Attorney
Hired an Attorney
Consulted a CPA
Hired a CPA
Consulted a Business Development Professional (MBA)
Hired a Business Development Professional (MBA)
Other
Are you a member of Chicagoland Christian Center?
*
YES
NO
If Yes, please provide your Member Number