Complete the form, scroll to the bottom and hit submit.
Questions? Please email Jean Barlage at:

Additional Reference  Printable Registration Form


Company Contact

Thank you for being the primary registration contact at your company.  CCIA we will rely on you to communicate any picnic updates to your registered guests if necessary.  As such, your email and best contact phone is required below.  

Company Name *
Registration Contact (First and Last Name) *
Phone/Cell *
Contact Email *

Number of guests and payment options

Register individuals or reserve table(s) of eight.  Please pay by credit card upon submission of this form, or mail a check to the CCIA office. 

Select Per Person or Reserve Table(s) of Eight *

Clear Selection
Total Number of Guests *
Total $ Due *
Payment Options: Please pay by credit card or mail check. *

Clear Selection

Guest list

If you register more than eight guests, please enter names in the text box below, or email Jean BarlageNote:  tables will be reserved for only those who request table(s).  Thank you for your understanding in advance!

1. First and Last Name
5. First and Last Name
2. First and Last Name
6. First and Last Name
3. First and Last Name
7. First and Last Name
4. First and Last Name
8. First and Last Name
Additional Attendees: Please enter first and last names of additional attendees.
(Maximum characters: 500)
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Fields marked with * are required.

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© 2020 Connecticut Construction Industries Association. All Rights Reserved.
912 Silas Deane Highway, Suite 112, Wethersfield, CT 06109 | P 860.529.6855 | F 860.563.0616 |



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