REGISTRATION FORM FOR
THE ANNUAL CAMPAIGN FUNDRAISING SEMINAR
WITH RABBI BROD


Wednesday, November 4th, 2026 / 24 Cheshvan, 5787
10:00 AM to 9:00 PM
The Shluchim Office, 816 Eastern Parkway

First Name
Last Name
Mosed
City
State
Country
Email
Cell
Tickets
Payment Info
Card type:
Name as on Card:
Credit card number:
Expiration:
CardID (CVV):?
Card Billing Address:
City:
Zipcode:
State:
Country:
Email for receipt: