Name:          

Address:                    City:        State:       Zip:    

Phone:                                                Email:   

School:                            Year:    2006 2007 2008 2009 Grad Student Community Member Alumni

Program:    President's Council Meeting, December 7

Providing us with your parent's information will help us keep them up to date with Jewish life around the region!

                        Mother's Name:      Mother's Email:

                              Father's Name:      Father's Email: 

                          Parent's Address:     Mother: City:  State:           Zip:

                                                                 Father:  City:  State:             Zip: 

                        Is your mother an alum of a New England school? yes no      If yes, which one?

                        Is your father an alum of a New England school?   yes no     If yes, which one?  

Tell me more about:

Social Programs  Holiday Programs  Social Action Opportunities    Trips  Learning Conferences   Outdoor Programs

Regional Student Board Jewish Student Projects Student Campaign    Other:  

  Sign me up for the regional list serv!

 

I have participated in:     NFTY    USY     NCSY     BBYO   Young Judea       Other: 

 

Have you been to Israel? no   yes, with  birthright israel young judea march of the living high school in israel semester/year abroad nfty usy ncsy My family Other:     If no, would you like to go? no yes