Shabbos and Recovery Shabbaton Registration

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Email *

—————————————————-

Do you have any food allergies? *

Cost *

Member – $120
Non-Member – $ 180
Scholarship request

Total Amont

$0.00

How will you be paying? *

Cheque
Credit Card

Signature *

Clear Signature

Confirmation:

By clicking “Submit” below, you are agreeing to participate for the entire weekend programming and to abide by the spirit of the Shabbaton.
If you are paying by credit card, you will be redirected to PayPal to process your payment after you click “Submit”.

Shabbos and Recovery Shabbaton Registration

—————————————————-

Please make your cheque payable to “Chai Centre Canada”

After you click “Submit” below, you will be redirected to process your payment.

Confirmation: