HebReg

What Hebrew language experience do you have?

Why are you taking this class?

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 BY 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:

Payment Information

Course Selection and Fees

No Tuition for Members of B'nai Zion.

$50 Tuition for 5 session classes / $20 Tuition for 2 session class

$36 Additional family member(s) or courses for 5 sessions / $18 Tuition for 2 sessions

Text and Materials need to be purchased by students. Contact the instructor if you need help ordering the materials.

Registration can be done with this form or by first class.

Payment should be made by first class. Make check payable to B'nai Zion.

Contact the instructor if payment plan is requested.

Other (please specify):

Fill in

amount: