Adult Education Registration Form

First Name

 

E-Mail

Last Name

 

Phone

 

       
Program You Are Registering For
Shalom Bayit Lecture
No Fee
  Farbrengens 
No Fee
Cholent & Sicha
No Fee
  Torah Studies 
No Fee
Rabbi Klatzkin Shabbaton      
Rabbi Klatzkin Shabbaton RSVP    
How many adults? 
$30/adult 
    How many children under the age of Bar/ Bat Mitzvah? 
$10/child 
 
Payment
CC Type   Card Number
Billing Address   City, State, Zip   
Charge Amount   Exp Date   
CVV