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SDLC ADDITIONAL REGISTRANT
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SDLC Additional Registrant Form

School Name
(You may want to copy the school name that you enter so that you can paste it onto additional registrant forms)
Please enter name of registrant below.  You will have an opportunity to add additional registrants after submitting this form.
First Name
Last Name
 Student  Adult
Title or Grade Level
# of previous times attending (complete this section for students only)
For information about registration contact: Diane Brewer, CAIS, (860) 572-2950 or d_brewer@caisct.org
Enter 1 in the box at right  @ $25.00
Form Total: $0.00

28A Cottrell Street, PO Box 159,
Mystic, CT 06355
P: (860) 572-2950 F: (860) 415-0835
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