Registration Form
Israel, Palestine, and the US 6-week course
Student Name
*
First Name
Last Name
Age
*
Please Select
under 18
18-24
25-40
41-64
65 and over
Location
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Phone Number
*
Payment
*
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next
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Class registration
$
100
Quantity
1
2
3
4
5
6
7
8
9
10
Registration with partial scholarship
$
50
Quantity
1
2
3
4
5
6
7
8
9
10
Registration with partial scholarship
$
25
Quantity
1
2
3
4
5
6
7
8
9
10
Registration with full scholarship
$
Free
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Credit Card
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
Additional Comments
Submit
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