YARCHEI KALLAH V-USA

Registration Form

Please print this form, complete it and send it with registration fees to:
Dr. B. Rubin
7801 Renoir Court
Potomac, Md 20854
Phone: 301.435.8034
Fax: 301.451.5424

1. Name
2. Address
3. Home phone
4. Business phone
5. Mobile phone
6. Email address
7. Fax number
8. Medical specialty
9. Level of learning:
I can learn from original (non-English) text yes
no
I can learn with chevruta yes
no
I require a tutor yes
no
10. I need help in finding lodging for the Yarchei Kallah yes
no
11. Are you interested in a Shabbat program? yes
no
Registration fees: Before 5 January, 2005 $400.00
After 5 January, 2005 $500.00
Send completed registration forms and fees to:
Dr. B. Rubin
7801 Renoir Court
Potomac, Md 20854

Confirmation of participation will be made upon receipt of registration fees.

For further information, please contact us at: Telefax:972-2-538-3558, Email: info@j-c-r.org


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Jerusalem Center for Research - Medicine and Halacha, P. O. Box 57058, Jerusalem, Israel
Phone and Fax: 972-2-538-3558, E-mail: info@j-c-r.org

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