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

Registration Form -- Hora Aviv 2009

Complete one form for each adult, then click the "submit" button below. Send your payment by regular mail (see below).

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

Name	First Last Gender
Street
City	State Zipcode
Country	Birthday Day
Telephone	Home Daytime Cell
E-mail (Print)
Registering as	Occupancy: Private Bath ?
Sharing room with (if any)	( if blank, we will assign your room-mate)

Meals	Age Group
T shirt	T-Shirt size Order T? (cost $15 if not bonus)
Children Attending?	Child 1 Name Age Meals? Bed? Child 2 Name Age Meals? Bed?
More Information	Anything else we should know?

No changes can be made after that.

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

Please print this form for your record and then transmit it.
Registration is effective when your payment (at least $100) is received. Send payment to :
S. Batzri. P.O. Box 8040, Silver Spring, MD 20907
(US checks and money orders only).

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