Diva Enrollment Form | Coffee Club Divas

Your Personal Information

This is info we need to process your enrollment. We use this information to keep you updated on Coffee Club Diva events, news, general info, and much more. This info will not go into the directory so please give us the best way to contact you.

Name*

First Last

Personal Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Personal Phone Number*

Personal Email Address*

Date of Birth*

Are you interested in any of these services? (Check as many as you'd like)

Please list any other interest(s) you have

Business Information

This info will be used in our public directory. This information is accessible to everyone. Please use appropriate email addresses, phone numbers, and addresses that can be made available to the general public.

I give Coffee Club Divas permission to list my business information below in the Diva directory that is accessible to the public.

Yes
No

Business or Employer/Organization Name*

Business Address

Same as personal address

Business Street Address Address Line 2 City State Zip Code

Your Title or Position*

Business Phone Number*

Business Email Address*

Does your business or organization have a professional logo?*

Yes
No

Upload your logo here for the Diva directory

Accepted file types: jpg, jpeg, png, gif.

Are you interested in getting a professional logo for your business?

Yes
No

Your Professional Bio*

Do you have a business website?*

Yes
No

What is your business website?

Are you interested in information about website development for your business?

Yes
No

Do you have a professional headshot?*

Yes
No

Upload your headshot for the Diva directory

Accepted file types: jpg, jpeg, png, gif.

Are you interested in getting a professional headshot or a business photo session?

Yes
No

Do you have a business Facebook or LinkedIn page?*

Facebook
LinkedIn
Neither

What is your Facebook business URL?

What is your LinkedIn URL?

Are you interested in information about Facebook business or LinkedIn page creation, optimization, or training?

Yes
No

Do you have any other links you would like to provide?

Do You Want to Offer a Diva Discount?

What category(ies) would you cassify your services? (Select as many as apply)*

Please list how you would categorize your product (Please note, this does not guarantee a new category creation in our directory)

I give Coffee Club Divas permission to list my business information in the Diva directory that is accessible to the public.

Yes
No

How Did We Meet?

Phone

This field is for validation purposes and should be left unchanged.

CONGRATULATIONS AND WELCOME DIVA!!

So why not get started on making your business more visible NOW?!

Your Personal Information

Business Information

How Did We Meet?

We look forward to seeing you in our directory!

Newsletter Signup

You have Successfully Subscribed!

Pin It on Pinterest