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Registration Form
Please, one person per form. (Fill out a separate form
for each person.)
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(Required fields have a red * next to them.) |
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Salutation & Name : |
*
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| Street Address : |
* |
| Street Address line 2 : |
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| City : |
* |
| US State / Canadian Province : |
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| Country : |
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| Non-US State/Non-Canadian Province : |
US & Canada leave blank |
| Zip / Postal Code : |
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| Home Phone (digits only) |
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* One of the phone numbers is required |
| Cell Phone (digits only) |
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| Email : |
* |
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an
Individual Member of the
World Congress. |
If affiliated with a World Congress member organization, which organization?
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Which of the following may we include in the "for attendees only"
printed directory? |
If you select, address,
phone, or email, your name MUST also be selected.
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interested in volunteering to help at the conference. |
If volunteering,
indicate special skills,
translation abilities, childcare, etc. |
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willing and able to sign for the hearing impaired. |
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I am interested in leading services and am a: |
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Do you need or can you provide home hospitality?
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All meals at the UCLA Hillel will be kosher. Friday night will be a meat meal
with vegetarian options.
The other meals will be buffets with vegetarian
options.
The Saturday night dinner at the UCLA Faculty Center will be
kosher style.
We will be contacting you for your meal choices..
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vegetarian meals |
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a kosher meal at the Faculty Center. |
I will need childcare for
children the following ages: |
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Comments:
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Current date and (Eastern) time:
May 16, 2012 at 22:34 hours
Please double check this form before submitting.
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Custom database and application by
DrewFaber.com
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