Tri-Valley Cultural Jews Enrollment Form
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Questions?
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Personal Information
Adult #1 Name
*
Your answer
Adult #1 Nickname
Your answer
Adult #1 Birthdate (mm/dd)
Your answer
Adult #1 Email Address
*
Your answer
Adult #2 Name
Your answer
Adult #2 Nickname
Your answer
Adult #2 Birthdate (mm/dd)
Your answer
Adult #2 Email Address
Your answer
Home Address
Your answer
City, State, Zip
Your answer
Home Phone
Your answer
Other Phone
Your answer
Which activities in the organization would you like to participate in?
Havdalahs
Membership
Publicity
Adult Programs
Newsletter/communications
Jewish Holidays
Jewish Culture School
Bar/Bat/Brit Mitzvah Prep
Other:
Is your home available for events?
Yes
No
Clear selection
How did you hear about our organization?
Your answer
Yortseits you'd like us to remember (name, date and relationship to you):
Your answer
Would you like to enroll your children in the Jewish Culture School at this time?
Yes
No
Clear selection
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