Business Counseling Services (BCS) Intake Form

Ready to launch a new venture, or grow your business, but not quite sure where to start? The Chamber's team of experienced business professionals are here to help you along the way. Our volunteer business advisors' possess many different backgrounds and areas of expertise. Take the next step in making your goals and dreams a reality by taking advantage of this program, at no cost to you.

Date *

Format: MM/dd/yy

First Name *

Last Name *

Mobile (cellular) Phone Number *

Land Line Phone Number

Primary Email Address *

Address Block - US

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

If your business is currently open, how long has it been open and what is the name of your business?

What service(s) or product(s) does your business serve or plan to serve? *

How would you like to meet with your advisor? *

In Person Email Phone Zoom Any

If other, what is your preferred method of meeting with your advisor?

If "Other" or "Word of Mouth" please share how you learned about this program.

Release and Waiver/Hold Harmless

For and in Consideration for my participation and or my continued participation in the activities and advising services provided by Volunteer Business Advisor through the Champaign County Chamber of Commerce receipt and sufficiency of which is hereby acknowledged, I hereby acknowledge the following:

I understand that the VOLUNTEER BUSINESS ADVISOR is a volunteer organization that the VOLUNTEER BUSINESS ADVISOR is not an employee of the Champaign County Chamber of Commerce, but is only a service provide in connection with the Champaign County Chamber of Commerce.

I understand that the Champaign County Chamber of Commerce does not control nor direct the VOLUNTEER BUSINESS ADVISOR as it only a program offering from the Champaign County Chamber of Commerce. The Champaign County Chamber of Commerce is therefore not responsible for the actions, errors, or omissions or negligence of the VOLUNTEER BUSINESS ADVISOR.

I agree to observe and obey all the rules and regulations associated with the services provided by the VOLUNTEER BUSINESS ADVISOR and those of the Champaign County Chamber of Commerce.

I understand that my participation in reliance on the advising services and activities of the VOLUNTEER BUSINESS ADVISOR is wholly voluntary and at my own risk and my application and or implementation of the advice I receive or participation in the activities and the advice does not come with any guarantee of success or result.

I hereby assume all risks, known and unknown, foreseeable and unforeseeable, patent and latent, that are in any way connected with or related to my participation in the advising services and activities of the VOLUNTEER BUSINESS ADVISOR and the Champaign County Chamber of Commerce.

I hereby release the VOLUNTEER BUSINESS ADVISOR and the Champaign County Chamber of Commerce and their respective directors, officers, officials, attorneys, employees, agents, volunteers, successors and assigns from all liability and waive all claims for any injury, loss or damage, including but not limited to attorneys’ fees, that are in any way connected with or related to my participation in the advising services and activities of the VOLUNTEER BUSINESS ADVISOR, whether or not the Claim is caused in whole or in part of the negligence of the VOLUNTEER BUSINESS ADVISOR or Champaign County Chamber of Commerce.

I authorize the VOLUNTEER BUSINESS ADVISOR or Champaign County Chamber of Commerce to use my name, or my businesses’ name, any photography, audiotape, videotape, sketch, drawing or other likeness of me or my business, for buy not limited to educational resources, press releases, web-based publicity and other publicity material sources, gratis, without any cost, fee or limitation whatsoever.

Binding Clause. I further covenant that this release and waiver/hold harmless shall be binding on myself, my partners, members, investors, heirs, executors, administrators, and assigns.

Severability. Each term and provision of this document shall be valid and enforced separately to the fullest extent permitted by law.

Applicable Law. This document shall be covered, construed and enforced in accordance with Illinois law, except for its conflict of laws provision.

THIS IS A WAIVER/HOLD HARMLESS AND RELEASE OF LIABILITY. BY SIGNING I ACKNOWLEDGE THAT I HAVE COMPLETELY READ AND FULLY UNDERSTAND THIS WAIVER/HOLD HARMLESS, RELEASE OF LIABILITY. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING THIS WAIVER/HOLD HARMLESS AND RELEASE, I HAVE BEEN GIVEN THE OPPORTUNITY TO CONSULT AN ATTORNEY OF MY CHOICE BEFORE SIGNING. MY TYPED NAME BELOW CARRIES THE FULL WEIGHT AND LEGAL AUTHORITY OF MY HANDWRITTEN SIGNATURE AND IS GIVEN VOLUNTARILY AND ABSENT ANY PROMISE, THREAT OR COERCION WHATSOEVER. *

Type Your Full Legal Name

Business Counseling Services (BCS) Intake Form

Building Business. Building Community.