CapitalDance.com Website ---- Registration Form --file ha

Registration Form -- Hora Aviv 2006

Complete one form for each adult. For online registration, click the "submit" button below.

Use the mouse or the TAB (forward) and shift-TAB (backward) key to navigate from field to field

Name	First Last
Gender	Male Female
Street
City	State Zipcode
Country	Birthday Day
Registering	Adult Non-dancing adult Child
Telephone	Home Daytime Cell
E-mail
Accommodation Desired	Double Occupancy Single Occupancy
Sharing room with (if any)	( if blank, we will assign your room-mate)
Private Bathroom	YES NO ( If blank, room with shared bath will be assigned.)
Age Group	Below 30 30's & 40's 50 & plus
Special Meals	Kosher Only (add $35) Vegetarian (If non selected, kosher style meals will be served)
About Children (under 6 yrs old)	Number of children attending: Select: Meals required? Y N Beds required? Y N
More Information	Anything else we should know?

No changes can be made after that.

Before you transmit, you may clear the entire form to start over.

Please print this form for your record and then transmit it.
Send your payment (at least $50) with this form to:
S. Batzri. P.O. Box 8220, Silver Spring, MD 20907
(US checks and money orders only).

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