Chanuka 2016 Shabbaton Registration

* First name:

* Last name:

Attending with a spouse?

Yes No

Spouse's first name:

Spouse's last name:

Number of children over age 14:

Number of children ages 5-14:

Number of children ages 3-4:

Number of children 2 and under:

* Email address:

Phone number:

Mailing address:

Apartment number:



Zip code:

Would you like to attend:

Important note on accomodations: our venue for this year, Embassy Suites Mandalay Beach, only has suites, not individual hotel rooms. When you sign up for standard accomodations, you will be placed either into a shared bedroom or a shared living room. If you'd like more privacy please select the appropriate option in the menu below.

Choice of accomodations: **

Any additional nights at the hotel?

Select additional nights:

Thursday Monday

Select a type of room for additional nights:

Would you like to request a roll-away bed (+$90)?

Yes No

Would you like to request a high chair (+$45)?

Yes No

Would you like to request in-room Wi-Fi (+$30)?

Yes No

Questions, comments, or special requests:

* required fields

** based on availability; for a description of accommodation options, please see Embassy Suites Mandalay Beach website

Please list the names and ages of your children so that we may direct them to the appropriate children's program:



Girl Boy
Girl Boy
Girl Boy
Girl Boy
Girl Boy
Girl Boy

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