Registration

Clip & Mail this form to:

PETER MATUSOW, Registrar

49 Westlake Road

Natick, MA 01760

Make checks payable to "NER-FJMC

SIGN ME UP! (Please print)

Name ________________________________________

Address ______________________________________

City _________________________________________

State _____ZIP ________________________________

Congregation __________________________________

Leadership Positions

List office, if any: ___________________________

Name to appear on Badge: _______________________

Email ________________________________________

Phone _______________________________________

Occupation ___________________________________

 

No price increase over last year!

 Discount rate (Paid in full by May 15) $270

 Regular rate (Min. $25 to reserve by May 15) $300

 Sponsor (Min. $25 to reserve by May 15) $350
 
 Patron (includes $50 to Tikvah Fund; send in $25 to reserve by May 15) $400
 First-timer rate (no cut-off date) $200

 Special rate for men 21 to 30 years old. $185
 
ACCOMMODATIONS:

[ ] Regular Bunk

[ ] Guest House ( Additional $55 pp, dbl. occ. )

[ ] Quiet Area Single Room ( No additional cost )

SPECIAL DIET:

[ ] Vegetarian meals

HONORS:

[ ] Aliyah [ ] Other_______________

[ ] Read Torah [ ] Read Haftorah

[ ] Lead Services________________________

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