Age-Friendly Business Certification Interest Form
Please complete this form in order to become a certified Age/Dementia-Friendly Business. Completing this form is the first step. If you have questions, please reach out via email, agefriendlyglencove@gmail.com 
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Today's Date: *
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Position *
Email *
Business Name *
Business Type *
Owner Name *
Business Address *
Phone Number *
Website 
How many employees do you have?
What kind of customer service training do you offer employees?
By signing this form, I acknowledge that I wish to begin the process of becoming and Age-Friendly Certified Business through the City of Glen Cove's initiative.  *
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