Registration Form Mr. Mrs. Ms. Dr. Atty. Rabbi *Name (First & Last): * Address: City, State, Zip: * Day Phone: * Email Address: * In-Person (Recommended) I'm interested in Zoom option How did you hear about this course? What questions do you hope to learn about in this series? Other Subjects You Would Like To See Offered: Comments / Other Areas of Interest: Chabad's policy is that no one will be turned down due to lack of funds For other options please call Rabbi Shaya at 860-232-1116 or email [email protected] Pay by Credit Card Credit Card Info: First Name: Last Name: Address: City, State and Zip: Credit Card Number: Exp. Date: (mm/yyyy) CSV #: Have a Promo Code? (optional) I will be sending in payment [Please send to: Jewish Learning Institute 2352 Albany Avenue, West hartford CT 06117 ] Please call me to discuss options Comments: This page uses 128 bit SSL encryption to keep your data secure.
