Please Please fill out the form below to register online for 
ANNUAL "LANES FOR LUPUS" BOWL-A-THON.

Name:

Email:

Address:

City:

State:

Zip:

Phone:

Team Name:

How many on your team?:

Do you need bumpers?:

YesNo

How many packets needed?:

Select time slot for blowing event:

10 am1 pm

CONTACT INFORMATION

Lupus Foundation of America, Connecticut Chapter, Inc. 
97 South Street, Suite 110 
West Hartford, CT 06110-1960 

Phone (860) 953-0387 
Fax (860) 953-0483 
Toll Free 1-800-699-6967 - CT only

Click Here for DIRECTIONS