Dobson Lagassé Centre Entrepreneur Support Network Registration Form Complete this form to apply to become a member of the Dobson-Lagassé Center Contractor Support Network. Name *FirstLastAge *Under 35 years old35 years old and overI am: *The ownerAn associateOtherIf you are a partner, please specify the proportion of shares currently held *Title of your position within the company *Company Name *Numéro d’entreprise du Québec (NEQ) – 10 digits) *Address *Address Line 1CityState / Province / RegionPostal CodeTel. OfficeTel. cell.FaxE-mail *Web Site / URLBusiness sector of the company: *RetailService Construction Transport AgricultureIndustrielTourismTechnologiesOtherPlease specify the business sector of the company *Spoken languages *FrenchEnglishOtherPlease specify the language *Year of foundation of the company: *Since when are you the owner/associate? *Number of employees *Address Line 1CityState / Province / RegionMain Business Market: *Eastern TownshipsQuebecCanadaUnited StatesOtherPlease specify the market *How did you learn about the Dobson-Lagassé Centre? *As Network Member, I will benefit of the various services offered by the Dobson-Lagassé Entrepreneurship Centre and, I agree to : Meet with a consultant of the Centre in order to present your business and to identify your needs; Participate actively in the Network activities; Pay the $125 fee for the membership period from September 1st 2020 – Aug. 31, 2021. *I understand and agree.Signature *FirstLastWebsiteSubmit
