Membership Application

(Please attach Business Card)

Business Name: _________________________________________________________

Business Address: ________________________________________________________

_______________________________________________________________________

# Years in this Business ________________

Business Telephone __________________Cell Phone __________________________

FAX ______________________________ Other Phone _______________________

Email Address

_______________________________________________________________________

Website

_______________________________________________________________________

Please describe your Primary Business

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Please describe your reason for applying

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Were you referred by another member? Yes No

If yes, who? _____________________________________________________________

Thank you very much for applying. Litchfield County Business Professionals are

committed to the success of each of it’s members.

Dan Tolman, President

Lori Riiska, Vice-President

Send completed application to:
Dan@YankeeNewEngland.com
Fax:   860-469-4403
Mail:  Dan Tolman, 101 South Road, PO Box 183, Winchester Center CT 06094

Or just hand it to any of our members!