2026 Registration Form for Los Angeles Shabbos of Chizuk

Los Angeles Shabbos of Chizuk

Registration Form
MAY 8-9 2026
שבת פרשת בהר בחוקתי
DELTA ONTARIO HOTEL
2200 E HOLT BLVD / ONTARIO, CA 91761
Full Name

First NameLast Name
Will your wife be attending with you?
Is your wife currently working in chinuch?
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name of the School Where You Teach
Which grade do you teach?
How would you like to be seated for the meals?
Children

Children may attend only up to age 3
How many children will be attending?
Please list the ages of all children who will be attending
Will you need a Pack ’n Play?
Are there any special requests we should be aware of?
Registration Fee

USDRegistration Fee

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Los Angeles Shabbos of Chizuk