Member - new member – CTGLC – Connecticut Gay & Lesbian Chamber

Welcome to CTGLC, we are thrilled to have you joining as a member.

By submitting this application, Applicants and Members agree to abide by the
CTGLC Standards of Ethics & Conduct.

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (260 char max):

Directory Category: *

Employees: *

Full-time Part-time

Business Keywords (enter a space between words):

Comments / Questions:

What types of events are you interested in attending?:

What is the maximum number of miles you are willing to travel for an event?:

Is there anything else that will improve the value of your membership?:

Would you be willing to host an event at your location?:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1:

Line 2:

City:

State:

Postal Code:

Country:

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Email: *

Contact Preference:

Email Phone

Password: *

Social Networking:

LinkedIn LinkedIn Facebook Page Twitter Facebook Profile

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Membership Options

Membership Package: *

$275 - Basic Membership: $275.00
1 Business and 1 person $650 - Premium Membership: $650.00
up to 3 people $1000 - Featured Membership: $1,000.00
up to 6 people

Payment Option:

Bill me Charge my credit or debit card

Print Application

Connecticut Gay & Lesbian ChamberAn LGBT Alliance for Business Opportunities

new member template

Member Application

Mailing Address

Address

Connecticut Gay & Lesbian Chamber
An LGBT Alliance for Business Opportunities