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
