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High Holidays 2010 Registration
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First Name
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Last Name
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Email
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Phone Number
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Birth Date (MM/DD/YY)
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I agree to be charged
Please Select One
$50 FOR AISH STUDENT (18-33 YRS OLD)
$50 FOR 2 FOR 1 SPECIAL FOR AISH STUDENTS
$100 PARENT OF AISH STUDENT
$200 NON-SUBSIDIZED PRICE
I am signing up for the 2 for 1 special and I have verified that my friend is new to Aish:
Please Select One
YES
NO
Friend's First Name
Friend's Last Name
Friend's Email
Friend's Phone Number
Friend's Birth Date (MM/DD/YY)
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Card Type
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Visa
Mastercard
American Express
Discover
Other
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Credit Card Number
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Expiration Date (MM/YY)
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Security Code
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Billing Address
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City, State, Zip
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I would like to be placed for holiday meals with a host family for:
Please Select One
MYSELF
MYSELF AND FRIEND
NEITHER
If yes, please specify whether you are interested in one or more of the following meals: 1st Day RH Dinner and/or Lunch, 2nd Day RH Dinner and/or Lunch, and/or Friday night dinner Sept. 10th.
I would like donate the following amount to help other students attend:
