L'Taken Seminar 2018 Registration Form
Please fill out this form in order to register for CBI's 10th Grade Confirmation trip to Washing ton D.C.
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
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Graduation Year *
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Home Address *
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City *
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State *
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Zip *
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Student's Email
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Home Phone *
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Cell Phone *
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Congregation Name *
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Dietary Needs *
(Vegetarian, Vegan, Gluten Free, Food allergies, etc.)
Your answer
Accommodations/ Accessibility Needs *
(ADA Room/ Down Allergy/ Braille Texts Etc.)
Your answer
Returning L'taken Student? *
Congressional District *
Click here to search your district: http://www.house.gov/representatives/find/
Israel Program 1st Choice *
Click to veiw Israel Program options: http://www.rac.org/israel-program-options
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Israel Program 2nd Choice *
Click to veiw Israel Program options: http://www.rac.org/israel-program-options
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Parent 1 First Name *
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Parent 1 Last Name *
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Parent 1 Email *
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Parent 2 First Name *
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Parent 2 Last Name
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Parent 2 Email
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2 Student Roommate Request
Choose 2 fellow participants that you would like to share a room with on the trip
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