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Leadership Application Form

The Business Leadership Circle
Awards Application

Note: You may apply using and submitting the form below. We have more information (including the TOP 10 Reasons to Nominate Your Company) a with a printable application in PDF format. PRINTABLE VERSION.  Items with * denote required information. All applications must be submitted by April 1.

Company Name:

Address:

City:

 State: Zip:

Phone:

Fax:

E-Mail:

Website:

Contact Person:

Title:

Person Submitting Application:
(If Different From Above)

Number of employees:

In Business Since:

In Bloomfield Since:

Provide a Brief Description of your Business

Growth in Annual Sales

Preservation of Jobs

Employment Growth & Opportunities

Business Expansion

Building Expansion or Renovations

Community Involvement

Product Line Diversifications

Market Diversification

Capital Investment

Chamber of Commerce Involvement

Additional Comments and Supporting Materials



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Bloomfield Chamber of Commerce 330 Park Avenue, P. O. Box 938, Bloomfield, CT 06002
phone:  (860) 242-3710