2024 Chapter Two For Men Application

Please complete the application below. There is a $125 administrative fee for participation payable upon acceptance to the program.

If you have any questions, please contact our Federation professional, Janice Obuchowski at 561-852-3271 or janiceob@bocafed.org. Thank you and we look forward to an engaging and fulfilling year ahead.

Sincerely,

Steven J. Klein & Stu Rubenstein

Co-Chairs, Chapter Two for Men

Janice Obuchowski

Associate Vice President, Campaign

Full Name*

First NameLast Name

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cell Phone*

Home Phone

Please enter a valid phone number.

Date of Birth (Please input date (M/d/yyyy)*

Years in Boca Raton or Delray area

E-mail*

example@example.com

Business title, name and phone number

Name of spouse (if applicable)

Name and ages of children (if applicable)

Name and ages of children

Synagogue Affiliation

How did you learn about Chapter Two for Men?

What do you hope to gain from your participation in Chapter Two for Men?