The Florence Melton Adult Mini-School FMAMS

Registration Form

1. Form details | 2. Payment

You may register in one of two ways:

A. Offline Registration

1. Click here for printable form
2. Mail completed form with a check for the $250 registration fee to:
Judy Kupchan,
FMAMS
North American Office,
601 Skokie Blvd., Suite 1A,
Northbrook, IL 60062,
USA.

B. Online Registration

1. Complete the form below
2. Click the "next" button to make your non refundable $250 registration fee payment online

* Mandatory fields

*Date of Israel Seminar:

Nov. 3-13, 2008 (Price: $2959)
Dec. 22, 2008-Jan. 1, 2009 (Price: $2959)
Returnees May 11-21, 2009 (Price: $3095)
June 22-July 2, 2009 (Price: $2959)
July 13-23, 2009 (Price: $2959)
Oct. 26-Nov. 5, 2009 (Price: $2959)
Dec. 21-31, 2009 (Price: $2959)

*Family Name:	*First Name:

*Street Address:	*City:	State:	*Zip Code:

Country:

*Telephone:	Fax:

Cell:	Email:

*Citizenship:	*Passport no:

*Date of Birth:(mm:dd:yyyy)	*Accommodations:
	Single Double *Single supplement: $1080 (except May Returnees: $1100) The program will bear responsibility for placing roommates up to six months prior to the seminar.

*Your Mini-School:	*Director's Name:

Physical conditions/health issues:

*Previous visits to Israel: None Once Twice More

*I heard about the seminar through:
Director	Teacher	Friend	Seminar Graduate
Brochure	Student Reader	Website	Other