Newtown Community Organization Summit

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* 1. Demographic Information

Name

Home or Business Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. On February 1, 2019:

I will be attending the Summit! Looking forward to it!

I will not be able to attend the Summit. Please keep me informed

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* 3. Which organization(s) will you be representing? (please limit to 2-3)

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* 4. What are the 3-4 topic areas your organization programs or provides
services around?

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* 5. Are there specific topics you would like to seek collaboration with other community organizations?

Thank you for your interest in the Community Summit on January 18, 2019. It will start at 10:00am-2:00pm in the
Alexandria Room in Edmond Town Hall. A light lunch lunch will be included. As a reminder, it will be beneficial if more
than one person can attend from each organization. There will be an opportunity to break into interest areas.
Organizations will want to ensure there is representation at the various break out interest areas. If you have any
questions, please call 203-270-4612 or email csw@newtown-ct.gov.

Question Title

* 1. Demographic Information

Question Title

* 2. On February 1, 2019:

Question Title

* 3. Which organization(s) will you be representing? (please limit to 2-3)

Question Title

* 4. What are the 3-4 topic areas your organization programs or provides services around?

Question Title

* 5. Are there specific topics you would like to seek collaboration with other community organizations?

* 4. What are the 3-4 topic areas your organization programs or provides
services around?