ENJC 2019 Purim College Connection
Sign-up form to send your college student a fun-filled package to celebrate Purim while away from home!
Requesting ENJC Member Name (First and Last) *
Your answer
Relationship to Student *
Requesting ENJC Member Phone Number *
Please provide a phone number we can use to contact you in case we have questions about your request.
Your answer
Student's Name (First and Last) *
Your answer
College Name *
Your answer
Address - Street *
Your answer
Address - Room#/Mailstop/Apartment etc...
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
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