2022 Celebration of School Leadership

• Date: October 20, 2022
• Time: Cocktail hour: 5:30-6:15 p.m. / Dinner: 6:15-7:30 p.m. / Award presentations: 7:30-8:30 p.m.
• Site: Saint Clements Castle, Portland, CT
• Registration Deadline: October 13, 2022
• Cost: $42 per person (cash bar)

Note: Items with * are required.
Registrant Name*:	First*: Last*:
Affiliation*: Choose a High School... Choose a Middle School... Choose a Elementary School... Choose a District Name... Other (not included in the options above)
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Payment Method*:	VISAMasterCardPurchase OrderSend Check
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Expiration Date*:	1 2 3 4 5 6 7 8 9 10 11 12 /20
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Billing City, State and Zip*:	CT AL AK AR AZ CA CO CT DE DC FL GA HI ID IA IL IN KS KY LA MA MD ME MI MN MO MS MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
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Attending in honor of:*	Mark AmbrusoCynthia CallahanDonna HaywardJamahl HinesDana PerezLauren ReidTwo or more of the above
Are you registering additional guests?*	YesNo
If yes, please indicate the total # of ADDITIONAL guests (max. 10 per reservation)?	12345678910
If yes, please indicate the names of additional guest(s) (one per line):
If any members of your party are vegetarian, please list his/her/their name(s) below.
If any members of your party have a food allergy, please list his/her/their name(s) and specific allergy(ies) below.