Registration for Shorashim- Purim- 3/5/2023, 10:00

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Registration for Shorashim- Purim- 3/5/2023, 10:00 - 11:00 AM

Email *

Name of person filling out this form on behalf of household. *

Phone Number *

How many people (𝗶𝗻𝗰𝗹𝘂𝗱𝗶𝗻𝗴 𝘆𝗼𝘂𝗿𝘀𝗲𝗹𝗳) in your household are attending? (Put # Here) *

Names of all people in your household who will be attending, 𝗶𝗻𝗰𝗹𝘂𝗱𝗶𝗻𝗴 𝘆𝗼𝘂𝗿𝘀𝗲𝗹𝗳. (Please put the ages of children in parenthesis). *

How did you hear about this program? *

BAS email

BAS website

Friend or family member

Facebook

Instagram

Westchester Jewish Council

Other:

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. *

A copy of your responses will be emailed to the address you provided.

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