Registration for Saturday Night aLive Poetry Cafe on April 13, 2024 at 7:30 PM

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Name *

Phone Number *

How many people (𝗶𝗻𝗰𝗹𝘂𝗱𝗶𝗻𝗴 𝘆𝗼𝘂𝗿𝘀𝗲𝗹𝗳) in your household plan to attend in person? (Put # Here) *

Names of all people in your household who plan to attend, 𝗶𝗻𝗰𝗹𝘂𝗱𝗶𝗻𝗴 𝘆𝗼𝘂𝗿𝘀𝗲𝗹𝗳. (Please put the ages of children in parenthesis). *

No charge, but contributions of wine or dessert are most welcome. If you will be bringing something, please indicate what you will bring here:

In signing my name below, I grant Bet Am Shalom permission to use photos of my family members, including children (neither photos nor captions will contain any names) in synagogue publications, including but not limited to: slideshows used at BAS, Newsletters, Emails, Fliers, BAS Facebook and Instagram Pages, and the BAS website. If you do not agree, please note: Do not use my photographs.
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A copy of your responses will be emailed to the address you provided.

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