Electronic Registration for Regional Convention

Program registration can be completed electronically using the form below or you may download the form in a pdf format. You will be notified how to make payment arrangements once your electronic form is received. If remitting form by mail, please be sure to include your check.

If you have any questions, please contact the Seaboard Region at seabd@uscj.org or 301-230-0801 ext 6.

Thank you.

Application Form

Download a printable copy of this form(.pdf) to fax or mail to Seaboard Region. (Pages 4 & 8 of the convention brochure)

*Denotes Required Information
Personal Information
* Last Name:
* First Name:
* MI:
* Salutation:
* Address:
* City:
* State:
* Zip Code:
* Phone:
Fax:
* Email Address:
* Special Dietary Needs:
*Hebrew Name :
I WOULD LIKE TO LEAD/ DO THE FOLLOWING(check all that apply)
Hamotzi Kiddush Birkat Ha-Mazon Z’mirot Weekday Mincha Kabbalat Shabbat Shabbat Maariv Shabbat Shacharit Shabbat Musaf Shabbat Mincha Weekday Maariv
Havdalah Weekday Shacharit Torah Reading Hagbah Gelillah/Golellet Gabbai
SUNDAY WORKSHOP PREFERENCE(select one for each session)
 
SESSION 1|10:30 am





 
  
 
SESSION 2|1:45 pm
Personal Information-Spouse or Second Registrant for household (if attending)
* Last Name:
* First Name:
* MI:
* Salutation:
Address:
only fill out address boxes if different than above
City:
State:
Zip Code:
* Phone:
Fax:
* Email Address:
* Special Dietary Needs:
*Hebrew Name :
I WOULD LIKE TO LEAD/ DO THE FOLLOWING(check all that apply)
Hamotzi Kiddush Birkat Ha-Mazon Z’mirot Weekday Mincha Kabbalat Shabbat Shabbat Maariv Shabbat Shacharit Shabbat Musaf Shabbat Mincha Weekday Maariv
Havdalah Weekday Shacharit Torah Reading Hagbah Gelillah/Golellet Gabbai
SUNDAY WORKSHOP PREFERENCE(select one for each session)
 
SESSION 1|10:30 am





 
  
 
SESSION 2|1:45 pm
Synagogue Information
* Name of Synagogue:
* City:
* State:
Current Position
Spouse or 2nd Registrant Current Position
Convention Packages (Registration Deadline is October 5, 2006. A $25 late fee will be charged after this date.
Please check one package per registrant. Please note that the hotel cost is not included.)
FULL PACKAGE
$200 per person
Includes registration fee and convention kit, meals from Friday Shabbat dinner though Sunday lunch and Saturday evening entertainment.
SUNDAY ONLY
$60 per person Includes registration fee and convention kit. Sunday breakfast and lunch.
 
 
 
Package Fee Per Person
 
Number of Persons
 
Amount
 
 
Full Package
 
$200pp
 
 
 
 
Sunday Only
 
$60pp
 
 
 
 
 
 
 
 
Total Fee
 
 
NEVER BEEN TO A SEABOARD REGIONAL CONVENTION BEFORE?
Please speak to your Synagogue President or Executive Director about a reduced registration rate. (This special rate does not include the hotel).
Thank You!