Applications


This application must be completed in full. All information will be considered confidential.
For any further questions, please do not hesitate to contact our office.

Required fields:*


Family Information:
Family Name:*
Titles:* &
First Names:*
Address:*
City, State, Zip:* , ,
My Children Information:
Names:
Age:
Gender:
We belong to Congregation / Shul / Community Center:*
For reference purpose please name Rabbi / Mentor:*
His / Her contact info:*
 
Your Contact Information:
Home Phone:*
Mobile Phone:*
Other:
E-mail Address (Mr):*
E-mail Address (Mrs):
 
Reservation Information:
I wish to apply for:* SHAVUOS
Join us for an inspirational 2 days and 2 nights! Scholar in Residence TBA

Price includes superior accommodations, all meals, entry to all lectures and workshops and childcare program. No tips or gratuities required. Babysitter tips welcomed but not required.
A non-refundable deposit of $95 is required to secure each families reservation.

We wish to pay this time:* Full cost of retreat
Deposit only
I would like to attend the retreat, but need to make special financial arrangements. Please accept this application as pending, and contact me regarding payment.
Do you have a coupon code?
Can you please accommodate the following special needs?
Please tell us how you heard of Ora V'Simchas Family Retreats:

Please note we endeavor to accommodate all special dietary or child requests to the best of our abilities. At times some requests cannot be fulfilled. We will call you if this is the case.


We wish to graciously sponsor the cost of another family (our size) that wishes to attend but requires full scholarship (your card will be charged twice). This gift is fully tax deductable and will be receipted accordingly.
 
Sponsorship Amount* $0
Total Amount* $0
Current Total Charge* $0

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