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

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


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