Shabbos with Rabbi Lopiansky Registration Form
July 9 - 11, 2021
Your Name
*
Prefix
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Spouse name (if applicable)
Prefix
First Name
Last Name
Spouses Email
example@example.com
Spouse Phone Number
Children's names and ages (If applicable)
Do you need a crib? if so please tell us how many:
Ex: yes, 1
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Room Occupancy (
*
single
couple
couple +baby in room
Couple with a connected Room for Kids
Couple with a separate Room for Kids
Room Options
*
1 King Size bed (option to add a cot)
2 double beds
Suite (1 available)
Would you like to add a cot in your room?
Ex: yes, 2
Allergies
*
Right 'none' if not applicable
Comments
Shortly after submitting this form you, will receive an invoice with the total amount due
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