School Name:
School Street Address:
City/Town: State Abbreviation: Zip Code:

Contact Person:
School Phone: Extension:
Fax:
Email:

Number of Students Attending:
Number of Chaperones: (please provide 1 for every 5 students)

                                (Filled) Tuesday, October 7, 2008 (Sorry, all classes are filled)
Date you will attend:
        (pick one)       (Filled) Wednesday, October 8, 2008

$10.00 per student fee.
Maximum 20 students per school.
Students receive a canvas duffle bag with hard hat, t-shirt, safety glasses and gloves.
Lunch is provided for students and chaperones.

For general questions regarding Construction Career Day, please contact:
Jennifer Balzarini
Federal Highway Administration
628-2 Hebron Avenue, Suite 303
Glastonbury, CT 06033
Phone (860) 659-6703 Ext 3003
or email to jennifer.balzarini@fhwa.dot.gov

*Mail Check (one check per school, payable to CCIA CT Construction Career Day Program) to:
Faith Gavin Kuhn
CCIA
912 Silas Deane Highway
Wethersfield, CT 06109

(Before submitting this form and mailing payment, please print a copy for your records)

           

Click here for printable Text Version of this form