CT HIGH SCHOOL STUDENT ENVIRONMENTAL SUMMIT

REGISTER NOW!

	Name:
	School:
	Grade:
	Email:
	Address:
	Phone:	Home Cell
	One Emergency contact:	Phone Relation to
	*Environmental Club
	*Your Role
	*Club Advisor
	Do you plan on spending the night?
	Do you plan on attending both days?
	Do you have any special dietary needs?
	Other:

Fields with * are optional
Maximum # Participants will probably be 50. If you exceed that number, you will be contacted shortly.
Thank you!
-Hannah