Become a Member

Company*

Primary Contact for EMSDC Information*

Name*

First Last

Title*

Email*

Work Phone*

Mobile Phone

CEO Information

Name*

First Last

Email

Phone

Chief of Procurement Information

Name

First Last

Email

Phone

Company Information

Headquarters Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Parent Company

Parent Company Address (if different than headquarters)

Street Address City State / Province / Region ZIP / Postal Code Country

Supplier Diversity Website*

If you do not have one, please list your page for vendor information or general website

Primary Industry*

Describe your organization’s mission, product and/or service:*

Why would you like to become a member of EMSDC? How can we best assist you?*

How did you hear about us?

Event / Presentation
EMSDC Staff Member
Other Corporation / Buying Entity
Diverse Supplier

What service/products are you interested in procuring? (i.e., office supplies, IT services, hardware, software, consulting, accounting, legal, facilities maintenance, staffing, etc.)

Do you have an MBE program?

Yes
No

Do you have a WBE program?

Yes
No

What year was your Corporate Supplier Diversity Program / Process established?*

Supplier diversity goals and objectives:

Preferred date to hold an UpNext Session:

Meet with MBEs in-person or virtually to share your supplier diversity process, goals, and upcoming opportunities.

Which EMSDC Programs and Events are you interested in sponsoring and / or participating in:*

Super Matchmaker
ROAR Conferences
Youth & Entrepreneur Scholarship Golf Invitationals
Choice Awards
Business Navigators Accelerator Program

Are you a National Corporate Member?

If unsure, please use this list to confirm: https://nmsdc.org/corporate-membership/corporate-members/

Yes
No

Is your business affiliated with other NMSDC Regional Councils?

Yes
No

If yes, which councils?

Number of employees

Annual Sales

Approximate annual purchases in the PA-NJ-DE region:

Approximate annual purchases with diverse suppliers in PA-NJ-DE region:

What is your Diversity Spend Goal for the current year?*

Specify the portion of the Diversity Spend Goal dedicated to minority-owned businesses.*

Do you have any procurement activities that target Tier 2 suppliers / vendors?*

What was your Tier 2 diversity supplier / vendor spend in the previous year?*

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Fiscal year end text*

Fiscal year end*

Budget/planning period month(s)*

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Associate
Corporate

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Associate
Educational Institutions
Corporate

Associate Price

Price:

Educational Price

Price:

Corporate Price

Price:

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Visa

Card Number Expiration Date Security Code Cardholder Name

Total

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