Face to Face: IBO Registration

Please fill out all of the fields of the form below and submit it. Your information will be kept confidential and will not be sold to anyone.

Your name

Are you male or female?

Your date of birth You must be 18 years or older to participate in the program.

Your telephone or cell phone number Please include country code and city code.

Your e-mail address

Your mailing address

Are you currently employed? Or, are you currently running your own business? If so, what type of business do you currently operate?

How many hours a day do you currently work?

Do you have any special training or skills?

Will you need to apply for a financial loan to purchase supplies?

Have you recently borrowed from a local bank or micro-lending institution?

[Optional] If you need to borrow, please provide us with the name, telephone number and e-mail address of an officer at the bank or micro-lending institution you have in mind to borrow from. If you like, we will contact that officer and discuss with them program details, including our loan guarantee policy.

Do you have a safe and secure place to blend, bottle and store your products? If not, we may be able to help you find such a place.

Are you familiar with any not-for-profit organizations in your community that provide women with healthcare, education, employment or any other type of assistance for free? If so, would you please provide us with their names, addresses and phone number?

Please indicate here any questions that you have regarding the program?

Do you have any special circumstances, conditions or disablilites that you think we should be aware of?

How did you learn about the program?

Here, you may add any other information about yourself that you may wish to. Please limit to 200 words.