Be Well Shared Kitchen
Membership Application

About Be Well Shared Kitchen

Mission Statement
Our mission is to empower Black and Brown farmers, growers, and entrepreneurs by providing opportunities, fostering equity, and creating sustainable ecosystems for their success.

Shared Kitchen Membership Application

Please fill out the form below to apply for membership.

Please specify the day and hours you plan to use the space:

Kitchen Space is available from 6:00 am until 10:00 pm
Enter times needed below

Personal Information

Your Name(Required)
Home Address(Required)
Current Business Address(Required)

Social Media Information

Do you have social media accounts for your business? (Optional)

Please provide links to your business's social media profiles:

Demographic Information (Optional)

Education & Certifications

Highest Education, Certifications Received:(Required)

Health & Safety

Professional Experience

Business Information

Services & Needs

Please select all the business-related topics or services you feel are the most beneficial to you:(Required)
What equipment do you need?

Membership Duration Selection

By submitting your application, you agree that all the information provided is accurate and true to your knowledge.

Clear Signature

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