Registration Form Havurah Shir Hadash in Ashland, Oregon “Reb Zalman Legacy Shabbaton with Eve Ilsen, April 24-26, 2015 Send or FAX to: Havurah Shir Hadash, P.O. Box 1262 Ashland, Oregon 97520 Phone: 541-488-7716 FAX: 541-622-0203 www.havurahshirhadash.org Questions? Contact Ayala at ayala@ashlandhavurah.org Registrants Names: 1.________________________________________________________ 2.________________________________________________________ 3. ________________________________________________________ Kids for childcare 1. _________________________________ AGE _______________ Please indicate name 2. _________________________________ AGE _______________ and age of each child 3. _________________________________ AGE _______________ Contact Info: Name __________________Phone ( )_____________ E-mail: ________________________ Address___________________________________________________________________________________ _________________________________________________________________________________________ Payment enclosed: • • • • • • Number Registration @ $225 each….……….………………………………………………... ______ Youth discount (subtract $75 for children and teens up to 18 years of age*)……….. ______ Mitzvah/optional donation to our special needs Scholarship fund………………… ______ Childcare Registration - $20 per child (childcare provided ONLY with advance registration) ______ Men’s Mikvah - $12-$18 per person (see FAQ’s for details)………………………. ______ Women’s Mikvah - $12-$18 per person (see FAQ’s for details)…………………… ______ • Youth 14-18 yrs are eligible for Work Trade Scholarship $ Total ______ ______ ______ ______ ______ ______ TOTAL DUE…………………………………………………………………………… ______ ______ Payment (your reservation will be held after full payment only): • Check enclosed [ ] • Credit Card: [ ] Visa [ ] Master Card [ ] American Express [ ] Discover Name as it appears on the card: ___________________________________________________ Credit Card Number: ________________________________________ 3-digit Security Code______ Expiration Date: ____________ REGISTRATION Registration is guaranteed by payment in full only. You may register by sending this form by fax or mail to FAX to: 541-622-0203 Or Mail to: Havurah Shir Hadash, P.O. Box 1262 Ashland, Oregon 97520 Additional info and forms available online at www.havurahshirhadash.org. We urge you to register early as space for this event is limited! 1 CANCELLATION POLICY $25 cancelation fee if you cancel before February 15; $50 cancellation fee if you cancel before March 15; $75 cancellation fee if you cancel between March 15 and April 24. CHILDCARE Please see FAQ’s – childcare will only be provided if registrations for childcare are received by March 15. WORK TRADE SCHOLARSHIPS We don't want finances to be a reason to keep anyone away, so we do have a limited number of work trade opportunities available. If you are in financial need and are willing and able to work 5 hours over the weekend please contact Ayala Zonnenschein at ayala@ashlandhavurah.org and write “work trade” in the subject line to arrange for a $75 work trade discount. You will be notified closer to the time of the Shabbaton in regards to what exactly your work trade is. We will send you a form where you can indicate your preferences and abilities, and we will do our best to honor that when possible. Accommodations – See our FAQ’s for info and rates. Shabbaton Tentative Schedule, April 24-26, 2015 Friday: 2-3:00 PM 3:30-4:30 PM 3:30-5:30 PM 6:30 PM 7:15 PM 9:30 PM-ish Woman’s Mikvah at the Jackson Hot Springs on Highway 99 Men’s Mikvah led by Reb David Pick up your registration packet at the Havurah 185 North Mountain Av in Ashland Registration and Sanctuary opens Kabbalat Shabbat (starts promptly...arrive early please) Oneg Saturday: 10 AM 1 PM-ish 1:45 PM-ish Davvenen and Torah service Lunch catered by Greenleaf Restaurant Shabbos rest or some wonderful one-hour workshops. 7:30 PM Evening Program TBA Sunday: 9:30 AM 10:30 AM 11:30 AM Shuk open and light breakfast Davvenen led by rabbis * Closing ceremony 2