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ACTION COMMUNITY SHABBATON REGISTRATION
Spring 2010 Semester, May 7th
Questions marked with a
*
are required.
*
1.
First Name
*
2.
Last Name
ADDRESS:
*
3.
Street
*
4.
Address City
*
5.
Address State
*
6.
Zip
*
7.
PHONE
*
8.
EMAIL
9.
Rooming Preference (Please name up to three people. Rooming is girls and boys seperate)
10.
Other friends you would like to be together with but not roomed with
*
11.
How would you like to pay?
Credit card
PayPal
Check
Cash
