Paths to Greatness & an Extraordinary Business Future

Wednesday, May 16; 8:30 AM – 10:30 AM

Mark Twain House
Lincoln Financial Auditorium
351 Farmington Avenue
Hartford, CT 06105

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Please complete the form below: (Fields indicated with * are required)

Your Name Mr. Mrs. Miss Ms. Dr.
First Name *	Last Name *
Your Title	Business Name
Address *	Address 2 (optional)
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Daytime Phone *	Email *
Please provide the following demographics so we can better describe for our grant supporters the communities we serve. (Your information will be used in aggregate totals only.)
What is your gender? Male Female
The state of Connecticut defines low and middle income households as those with aggregate earnings below $112,600. Do you consider yourself to be part of this group? Yes No
Is the business you are associated with: (Check all that apply) Minority-Owned   Women-Owned   Veteran-Owned
How long has the business you are associated with been in operation? (please enter 0 if not yet operating)
Number of Employees (please count yourself)
How did you learn about this event?
Select one * I am a current CEDF loan client I am a CT small business owner but not a CEDF client I am interested in small business education topics but not a business owner I am a guest of CEDF

Referral Information

Please specify the person's name and organization that referred you for these class(es).

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