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Name:        
E-mail:       

School: 
Major: Status:
Year of Graduation:

Campus Address: Apt #:
Zip Code:
Campus phone.:    Cell phone.:

Address back home

Street: Apt #:
City: State:
Zip Code: Country:
Telephone No.:

Hebrew Name (approx):

Hebrew Birthday (if known): or Date of Birth:

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Optional Information
(Please fill in as much as you feel you can)
Father's Hebrew Name (approx):
Mother's Hebrew Name (approx):

I am interested in:

Jewish Studies

Hebrew reading
Torah
Philosophy
Law & Ethics
Prayer

Special events

Shabbat & Holiday meals
Lectures & Workshops
Parties, Felafel Nite, movies
Holiday celebrations

I would like to help with

Comments/suggestions: