JDC Summit Registration Form

Jewish Deaf Congress Summit Registration Form

The purpose of the JDC Summit is to assemble Jewish Deaf People who are interested in contributing ideas, helping to determine priorities for future growth, both personally and for the community via JDC programs, and becoming part of the Jewish Deaf community's future.

1. Your Name

First Name Last Name

Street Address

City, State, Zip, Country

Email Address

example@example.com

Mobile Text:

VP:

2. What is your preference of pronouns?

He/Him/His She/Her/Hers Ze/Them/Theirs I do not use a pronoun Other

3. Please check your age group:

18-25 26-36 37-55 55 and above No Comment

4. Please check up to two (2) reason(s) why you want to attend the JDC Summit:

To socialize and network To share my interest in and ideas for the Jewish Deaf community's future To learn more about Judaism To take on leadership role with JDC or my community To embrace my Jewish Deaf identity Other

5. Are you a member of a synagogue, Jewish organization, and/or Jewish Deaf Synagogue/organization? If yes, please name the synagogue and/or organization.

6. Communication Accommodations: Inasmuch as this Summit is for Jewish Deaf ASL users, the Summit will be conducted completely in American Sign Language (ASL Interpreters will not be provided). Please check one of the following communication accommodation options needed.

I do not need any accommodations Close Vision Interpreter Protactile Interpreter Other

7. Food Restrictions: All meals will be Kosher during Summit

Regular / No Food Allergies Vegetarian Vegan Gluten Free Other

8. Lodging Accommodations, please check more than one if needed. If you check on "other" to fill name, go ahead and check on "other", it will show up for you to type in.

Single Occupancy @$450 Double Occupancy @$375 *If double occupancy, please fill in roommate name in "other". A separate registration for a roommate and payment will be needed. Thank you. Do you need help finding a roommate to offset costs? Other

9. Pay registration, please choose package:

Single Occupancy Summit Fee: $450 p/p Single Occupancy 2-night lodging, six organic kosher meals, shabbat services, workshops & social events

$ 450.00

Double Occupancy Summit Fee: $375 P/P Double Occupancy 2-night lodging, six organic kosher meals, shabbat services, workshops & social events

$ 375.00

Total

$ 0.00