Rabbi Jana's Class Registration and Payment Information Form
PLEASE COMPLETE THIS FORM AND CLICK "SUBMIT" AT THE BOTTOM OF THE PAGE.
PAYMENT IS DUE ON OR BEFORE THE FIRST DAY OF CLASS*
First Name:
Address 1:
Home Phone:
E-mail:
Work Phone:
Last Name:
Address 2:
City:
State:
ZIP:
Hebrew Name:
(if known)
Occupation:
What other languages have you learned / studied?
Other (please specify):
Congregational Affiliation:
Other:
Where you heard about the courses:
Tuition Payment
Payment by Check, Credit Card or Cash should be made before first class*.
Make a secure online payment to B'nai Zion (Credit card, debit or e-check) HERE (opens in a separate window to be able to return to this submit this form after paying)
(Members please login to make the payment)
Everyone should select:
- PAYMENT is for Account Balance
- TYPE is Adult Education (from the pull-down list)
- AMOUNT to fill in is: $54 for Members of B'nai Zion or $72 for Non-members
