Connecticut Co-Act


Participant Application

Participant Application

CANAAN Community Connections Canaan CT 00618


Application for:  _________________________________________________________

                                (Participant's name)


Mailing Address: _________________________________________________________


Phone: ___________________________   E-mail: _______________________________


 Describe Organization_______________________________________________________

List products you will sell: _______________________________________________________

 *Farmers/vendors will supply their own tables and canopy/tent/for their products.

*Farmers/vendors will provide a liability insurance certificate, if necessary.


Signed:_______________________________________   Today’s Date: ___________


Print name: ___________________________________________________________


Please mail the completed application to:

Bob Alonge

 Attn: CTCo-act

8 E. Main Street

Canaan, CT 06018 

Questions:  Bob Alonge -   [email protected] (781-413-7604)

                 Application-Mailing should include:

  1. Application form
  2. Donations payable to: The Community Mission
  3. Attach copies of health dept. permits, insurance certificate, sales/use tax registration


For Office Use: 

____ Check enclosed         _______ Amount Received ____ Date Check Received


Application for:

Participants and far