First Name*

Last Name*

Email*

Phone*

Other Phone

House of Worship/Partner*

 Not Yet Listed/Does Not Apply
 Abdul-Majid Karim Hasan Islamic Center Hamden
 Center Church on the Green New Haven
 Congregation Beth El-Keser Israel New Haven
 Congregation B'nai Jacob Woodbridge
 Congregation Mishkan Israel Hamden
 Dixwell Avenue Congregational UCC New Haven
 First Presbyterian Church of New Haven
 First United Church of Christ Milford
 Jewish Federation of Greater New Haven
 Mary Taylor Memorial United Methodist Church Milford
 Muhamad Islamic Center of Greater Hartford
 Muslim Coalition of Connecticut
 Regional Baha’I Council of the Northeastern States
 Saint Andrew's Episcopal Church Madison
 Saint Peter's Episcopal Church Milford
 Shalom United Church of Christ New Haven
 Temple Emanuel Orange
 Trinity Church on the Green New Haven
 Woodmont United Church of Christ Milford

If not yet listed, the name of your House of Worship/Organization (if does not apply, please skip)

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If a group, how many are in your group including yourself:

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