Participant Name: _________________
Agency Name: ___________________
Address: ________________________
________________________
Phone: ________________________
E-Mail: ________________________
T-shirt size: ______________________
P.O./CHECK # ________________________
Confirmation will be sent upon receipt of registration. Space is available on a first-come, first-served-basis.
Registration can be mailed to:
201 Miller Road, Bethany, CT 06524
or
Faxed to 781.465.6102.
