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The following registration
form must be completed and sent, with full fee enclosed
to:
JACS of Florida
c/o Rabbi Nahum Simon
8358 West Oakland Park Blvd.
Suite 203-C
Sunrise, FL 33351
Please answer all questions
Information is used for this JACS Retreat only
Name
______________________________________________________
Address
____________________________________________________
City ____________________________ State
______ Zip____________
Tel: (day) __________ evening)________
Email ____________________________
Is this your first time at a JACS retreat? _________
Would you like a buddy? Yes No
I would like to lead a workshop or meeting.
Which fellowship? _____________________________________________
I would like to room with?
______________________________________
If we need to assign you a roommate:
Are you a Sabbath observer? Yes
No
Do you Smoke? Yes No
Are you bringing a nursing baby in arms?
Yes No
Will you need a ride from the airport?
Yes No
Fee enclosed $_______________
Mastercard/Visa: _________________________
Expiration Date____________________
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