Ion Bank Foundation - Community Awards Program 2016

28 South Orchard Street
Wallingford, CT 06492
203.294.9722

To empower the people of Wallingford to meet their own communication needs, as they define them, by facilitating digital media creation and managing its public Distribution

Wallingford Public Access Association, Inc

Name:

Address:

City:

State:

Zip Code:

Phone Number:

*All fields are required

*First Name:

*Last Name:

Suffix:

*Address:

*City:

*State:

*Zip Code:

*Phone Number :

*Date of Birth:

*Last 4 digits of Social Security #:

Enter the code shown above:

(Note: If you cannot read the numbers in the above image, reload the page to generate a new one.)