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“Capture Connecticut’s Heritage”

Registration Form

Name:______________________________ Tel. _______________________________

Address: _______________________________________________________________

E-Mail: ________________________________________________________________

Work(s) to be exhibited: __________________________________________________

Medium: _______________________________________________________________

Send registration form BY JUNE 10^th to:  Mrs. William Chittenden,
31 Leffingwell Road, Clinton, Connecticut  06413, along with your $20
registration fee. Checks should be made payable to “NSCDA – CT.”

Call the Webb-Deane-Stevens Museum at (860) 529-0612 with any
questions or contact Mrs. Chittenden at chittenchat@sbcglobal. net.