Basic Fees # of People Amount
Fees (incl tuition and meals - rooms may be reserved at the Windmill Suites - mention KALLAH)
Adult $750 X _______ = $___________
Teens (13-18) $650 X _______ = $___________
Children (4-12) $550 X _______ = $___________
Children (1-3) $300 X _______ = $___________
SUBTOTAL COMMUTER $__________
Shabbat
Shabbat only w/meals $295 X _______ = $___________
SUBTOTAL SHABBAT $__________
Special Discounts
5% First Timer (5% for each first-time participant) OR
5% Register w/a minyan (only if 10 register together) X _______ = $___________
Early Bird discount (Postmarked by December 15, 2009) X _______ = $___________
$25/person
TOTAL DISCOUNTS $__________
Additional Fees
Supplementary fees for classes (art, etc) as noted X _______ = $___________
Tuesday arrival $150 X _______ = $___________
ALEPH Membership (Tax deductible) X _______ = $___________
Late Fee (if not paid by Jan 5, 2010 $50/person X _______ = $___________
Additional tax deductible donation (please circle)
Scholarship Fund General Fund $_____________
TOTAL ADDITIONAL FEES $__________
____ Check for work-study and enclose formal application
GRAND TOTAL (Subtotal plus fees minus discounts $ _______________
Amount enclosed (minimum $150 per person before Dec 25) $___________
Balance due by Dec 25, 2007 (After Dec 25 must be paid in full) $___________
Visa/Mastercard/Discover/American Express#
__________ - __________ - _________ - _________ expiration _______ Card Security ID# ________
Please charge my balance on ____ Dec 15 (early discount) _____Dec 25 (regular registration)
If paying by credit card, please make sure the address above matches your billing address)
ADULT #1
Name (as you want it to appear on your name tag ______________________________________________________
Birthdate (m/d/y)_______________________ Sex: F M
Address ___________________________________________________________________________________________
Day phone ( ) _________________ Eve phone ( ) _________________ fax ( ) _________________
Occupation _______________________Email___________________________________ OK to email ? __Y__N
COURSE PREFERENCES - list using course numbers. Courses are filled in order of postmark.
If more space is needed, please copy sheet. Also, please indicate whether you selected this course primarily for the topic or the teacher.
AM: 1st choice ______ topic/teacher 2nd choice ______topic/teacher 3rd choice _____ topic/teacher
PM: 1st choice ______ topic/teacher 2nd choice ______topic/teacher 3rd choice _____ topic/teacher
Are you interested in: (check all that apply) Choir Kallah musicians
ADULT #2
Name (as you want it to appear on your name tag ______________________________________________________
Birthdate (m/d/y)_______________________ Sex: F M
Address ___________________________________________________________________________________________
Day phone ( ) _________________ Eve phone ( ) _________________ fax ( ) _________________
Occupation _______________________Email____________________________________ OK to email ? __Y__N
COURSE PREFERENCES - list using course numbers. Courses are filled in order of postmark.
If more space is needed, please copy sheet. Also, please indicate whether you selected this course primarily for the topic or the teacher.
AM: 1st choice ______ topic/teacher 2nd choice ______topic/teacher 3rd choice _____ topic/teacher
PM: 1st choice ______ topic/teacher 2nd choice ______topic/teacher 3rd choice _____ topic/teacher
Are you interested in: (check all that apply) Choir Kallah musicians
CHILD/TEEN #1 Name__________________________ Birthdate _______ Sex: F/M E-mail _________________
CHILD/TEEN #2 Name__________________________ Birthdate _______ Sex: F/M E-mail _________________
OTHER INFORMATION
Dietary Needs (circle all that apply): Lactose intolerant Wheat allergy Vegan Other ________________
Do any health issues require special consideration? (Please explain.) _____________________________________
How many previous Kallot have you attended? ____ What year was the last one you attended? _______
How did you hear about the Kallah?__website__friend__brochure__other (specify)
Please rank your top 3 reasons for attending Kallah (place a 1, 2 & 3 in front of reason):
__Community ___Re-entry into Judaism ___Davening ___Experience Jewish Renewal ___My family
__Hoping to meet my Basherte (soulmate) ___Learning (specify if particular teacher) ________________
How are you affiliated? __Renewal __Recon __Conserv __Reform __Havurah __Orthodox ___other
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