OA Shabbaton Registration Form

Shabbaton Registration

Fill out this form, answer all questions, and submit your payment to be registered for the Shabbaton
Name

First NameLast Name
Name on Badge
E-mail
example@example.com
Phone Number
The number provided may be used to contact you via WhatsappFormat: (000) 000-0000.
Do you want to be included in the phone list?
Address

Street Address

Street Address Line 2

CityState

Zip Code
Who do you wish to have as your roommate?
Hebrew Name for Tehilim
Fellowship name
Are you available to sponsor?

Double Occupancy Room Fri-Sun

October 5-30

$290.00

Single Occupancy Room Fri-Sun

October 5-December 6

$500.00

Babysitting

$90.00

7th Tradition

Help pay for others to attend

$10.00

Total

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Please Note: This registration fee is not refundable for any reason. NO EXCEPTIONS WILL BE GRANTED.
Should be Empty:

Shabbaton Registration