Registration for Participation

Senator John T. Yudichak, Carbon County SAFE Kids, the Carbon County Commissioners
 and the Carbon Lodge #242 Free & Accepted Mason’s
In partnership present the

CARBON COUNTY COMMUNITY SAFETY DAY
(Formerly the Fun – N – Safety Fair)


May 3, 2014 (rain or shine)
10:00 a.m. – 2:00 p.m. 
Mauch Chunk Lake
Lentz Trail
Jim Thorpe, PA 18229

* Please fill in following survey if you plan on attending.
 We need your response by 4/18/2014. 
You can email to mjg26@psu.edu or fax to 570-325-2805.

* REMEMBER…An activity focused to children is required in order to participate. 
You can hand out promotional items and agency information. 
You must provide your own table, chairs and tents.
 If you want to join the fun and are unable to think of an activity please
 contact Mindy Graver (570-325-2788) or Evalynn Kuehner (570-325-2771) from Safe Kids.
 We can use help with some of our Safety Town activities or can help you with ideas.

Agency Name: 
                                                                                                                           
Agency Address:                                                                                                                                                            
                                                                                                                                                                                    
                                                                                                                                                                  
Agency Phone #: 
Email address:
                                                                        
Contact Person:                               
                                                                                                
Number of staff/volunteers attending:        
                                                                                                            
Description of activity planned:  


Space needed for activity:     

Do you require electricity?