DIA: Jewish Connections Private Tours

DIA: Jewish Connections Private Tours
Name*

First NameLast Name
Email*
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Address*

Street Address

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Postal / Zip Code
Cell phone number (so we can contact you day of, if needed)*
Please enter a valid phone number.
Are you already working with a JHSM tour director?*

Yes! Barbara CohnYes! Sue KaliskyNo, not yet. Please contact me.No, I am a tour participant making a payment.
Please list some options of days and times you would like your tour.
Please enter the day and time of your tour and/or docent's name below.
How did you hear about this tour?
Are you a current JHSM member?*

YesNo, but I wish to join and take immediate advantage of member pricingNo, and I do not wish to join
Please select the membership you wish to purchase:
How many JHSM-member tickets ($18 each) would you like to purchase?
How many nonmember tickets ($25 each) would you like to purchase?
Would you like to add a tax-deductible donation to JHSM?

$18$36$50$118Other
Please list the name of each person you are registering (excluding yours):
Please use this box to communicate any feedback or any special needs about your tour. Thank you!
Total Due:
Payment Options:

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If paying by check, please print this form and mail it along with your payment to:

JHSM

33228 West 12 Mile Rd., #349

Farmington Hills, MI 48334
PayPal/Credit/Debit Total Due:

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