Summer Learning Retreat 2022

Page 1

Contact Information

Title

Pronouns

First Name

Last Name

Email

Email Type

Phone

Phone Type

Birthday

Sign me up for the Hadar general mailing list!

Home Address

Country

State

Street Address

City

Provinces

State/Province

Postal Code

Accessibility

Do you have any accessibility needs? If so please indicate below:

May we share your contact information with other participants?

We will only share your name and email address.

Stripe Billing ZIP

Mailing Campaign ID

Skip payment

Skippayment

Paying?

Page 2

Background Information

Do you identify with a particular Jewish denomination or movement?

What was the primary type of Jewish education you received as a child?

Payment Information

We believe that finances should not be an obstacle to participation and want to make sure that all who wish to learn with use will be able to. Please don’t hesitate to contact programs@hadar.org if finances pose an obstacle to participation. We would love to learn with you!

Payment Sliding Scale ($36-360)

Amount

Minimum amount is $36.

Payment Card Details

Use the name and email from the first page for the payment

Name On Card

Billing Email

The receipt will be sent to this address

Billing ZIP Code

Card Type

Card Number

Month

Year

Code

Are you a human?

** Card information is not stored by Hadar **

Stripe Name

Stripe Email