Complete this form to join Capital District Local First.

Applicant Details

Affiliation

Member Business

Please enroll my business or nonprofit organization as a member of Capital District Local First.
I am enclosing a check for annual membership dues. ($100 for businesses with up to 5 locations, $250 for businesses with 6 or more.)
My business or nonprofit organization is locally owned, independently operated, and headquartered in the New York counties of Albany, Rensselaer, Saratoga, or Schenectady.
My business is not a formula business (e.g. franchise), publicly traded, or a retail outlet owned by a publicly traded corporation.

Individual Supporter

Please enroll me as an individual supporter of Capital District Local First.
I am enclosing a check for $25 or more for annual membership dues.
Everyone is welcome to become an individual supporter, including those not eligible to join as member businesses.

Contact Name

Enter full name, eg. John Smith.

Organization

Enter the name of your company or organization.

E-mail

Enter your email address.

OK to publish email address

Telephone Number

Enter your business telephone number.

Location

Your location - either city and country - or in a company setting, where your office is located.

Street Address:
City, State and Zip:

Website

Enter URL of your website or home page, eg. http://www.acme.com

Tagline

Enter the tagline for your business or organization

CDLF Presence

Do not list me on the CDLF website

Do not include me on the CDLF mailing list

Verification Code

To help us prevent abuse, please enter here the six letters shown in the image below.