REGISTRATION
Please print and mail to:
Joined To HaShem
PO BOX 1816
Seminole OK 74818
INFORMATION MAY ALSO BE CALLED IN TO 405 382 2980
(NO CALLS ON SHABBAT PLEASE)
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NAME(s)
________________________________________________________ AGE_______(Write Adult if over 18)
________________________________________________________ AGE_______
________________________________________________________ AGE _______
________________________________________________________ AGE _______
________________________________________________________ AGE _______
________________________________________________________ AGE _______
Use back if needed
*If you have children under 11 please call our office to be scheduled for your session
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ADDRESS
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PHONE NUMBER
HOME____________________________
CELL_____________________________
EMAIL ADDRESS_____________________________ |
WILL YOU BE ATTENDING ALL NIGHTS OR PARTIAL?
ESTIMATED DAY YOU WILL ARRIVE |
COST
FULL WEEK
NUMBER OF ADULTS _____@ $50 = TOTAL_______
NUMBER OF YOUTH ______@ $40 = TOTAL_______
NUMBER OF CHILDREN _____@ $20 = TOTAL_______
PASSOVER MEAL ONLY
NUMBER OF ADULTS _____@ $20 = TOTAL_______
NUMBER OF YOUTH ______@ $15 = TOTAL_______
NUMBER OF CHILDREN _____@ $5 = TOTAL_______
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I WILL BE STAYING IN TENT________ RV_________ MOTEL________
I WILL BE DRIVING _________ FLYING_________ |
PAYMENT
CHECK ENCLOSED_______
CREDIT OR DEBIT CARD NUMBER_____________________________ EXP DATE_____________ CID NUMBER ON BACK___________
(Master Card or Visa only) |
SPECIAL NEEDS OR COMMENTS
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