Chanuka 2022 Shabbaton Registration

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* First name:

* Last name:

Attending with a spouse?

Yes No

Spouse's first name:

Spouse's last name:

Number of children ages 14 and older:

Number of children ages 4-13:

Number of children age 3 and under:

* Email address:

Phone number:

Mailing address:

Apartment number:

City:

State:

Zip code:

Would you like to attend:

All prices are double-occupancy (at least two adults per room, unless you request a private room); children in room with parents.

For singles: Would you like to request a private room (+$170+tax/night)?

Yes No

For families: Would you like to request a separate room for your children (+$170+tax/night)?

Yes No

Would you like to request a crib (+$26/night or $48 for basic program or +$70 for full program)? **

Yes No

Would you like to request a highchair (+$26/day or $48 for basic program or +$70 for full program )? **

Yes No

Would you like to request connecting rooms (+$25+tax/night)? **

Yes No

Would you like to request a Deluxe King room with a Marina view (+$36+tax/night)?

Yes No

Would you like to request a Two-Queen room with a Marina view (+$48+tax/night)?

Yes No

Questions, comments, or special requests:

* required fields

** Connecting rooms, cribs, and highchairs are limited and are first-come-first-serve.

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

Name:

Age:

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

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