Couples Shabbaton Sign Up Form
Information submitted through this form is sent encrypted and will be kept entirely confidential. Your credit card will not be billed until you are contacted and accepted for the weekend.
Husband's Information
Husband First Name *
Your answer
Husband Last Name *
Your answer
Husband Email Address *
Your answer
Husband Daytime Phone Number *
Your answer
Wife's Information
Wife First Name *
Your answer
Wife Last Name *
Your answer
Wife Email Address *
Your answer
Wife Daytime Phone Number *
Your answer
Address
Street *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Home Phone
If Applicable
Your answer
Other Questions
Name of Your Shul/Synagogue
Your answer
Name of Your Rabbi
Your answer
Date Married *
Your answer
Please list how many children you have, their names and year of birth *
Your answer
Will You Be Bringing An Infant? *
Required
Infant's Name?
Your answer
Infant's Age?
Your answer
Referred By *
Your answer
Payment Options
Cost of Weekend: $375 Per Person.

A deposit of $300 must be made right away to reserve space for the weekend. All payments must be made by November 20.

Payment plans are available. Please inquire with the Emet office for further information.

$75 Additional fee per child, including limited babysitting.

Cancellation policy:
Before November 9 - a full refund will be given.
After November 9 through November 20 - a 50% refund will be given.
After November 20 - no refunds will be available.

I Will Pay With *
Cash & Checks Can be brought or mailed to the EMET office: 185-12 Union Turnpike 2nd Floor Queens, NY
Credit Card Information
Name on Card
Your answer
Credit Card Type
Credit Card Number
Your answer
CVV Code
Your answer
Expiration Date
Your answer
Amount To Be Charged To Credit Card
Your answer
Miscellaneous
Please Let Us Know of Any Dietary Concerns
Your answer
Notes
Your answer
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