THE J² REGISTRATION FORM.

PLEASE FILL IN THE REGISTRATION IF YOU WOULD LIKE TO BE ADDED TO A WAITLIST.

Registration for the PAS: Women's Portugal Trip is closed. We are excited that you are interested in participating. Please fill in the form below if you want your name added to the waiting list. You will be receiving additional correspondence from us if space becomes available.

TRIP NAME

Park Avenue Synagogue | Women's Trip to Portugal | Led by Rabbi Lori Koffman and Cantor Mira Davis with Scholar Henrique Cymerman

CONTACT DETAILS

SURNAME

FIRST NAME

MIDDLE

PRONOUNS

(Optional) What are your pronouns? (e.g. she/her, he/him, they/them, use my name) For information

about pronouns, please see: https://urj.org/quick-guide-pronouns

PLEASE ADD YOUR ROOM PREFERENCE: SINGLE, DOUBLE, TWIN, CONNECTING, ADJOINING, AND ADD NAMES OF OTHER(S) SHARING YOUR ROOM.

PASSPORT INFORMATION

DATE OF BIRTH.

PASSPORT NUMBER

EXPIRATION DATE.

CITIZENSHIP

FULL CONTACT INFORMATION

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EMAIL

MOBILE

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