Name* Mr.Mrs.MissMs.Dr.Prof.Rev.Mx.None Prefix First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Business PhoneCell PhoneBirthdate MM slash DD slash YYYY How did you hear about CHS?CHS SupporterCHS VolunteerCHS EventFriendsEmployerSocial NetworkDirect MailingsEmailsPrint AdvertisementsRadioFlyersOtherIf other, please enter how you heard about CHS.Name of Group*Age of Group Members*Number of People in Group*Which location would you like to tour?*NewingtonWaterfordWestportPreferred date and time for tour.*Type of donation.*Limited scholarship funds are available. If you are experiencing a hardship that would prevent your group from participating, please select “scholarship” to be considered.$50 cash/check/credit cardIn-kind donationScholarshipCAPTCHA
