Teva Learning Center - Jewish Environmental Education Seminar

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Organizations Billing Information

Please fill out the information below for the organization sponsoring these participants. To include yourself as a participant please enter your information in the Participant Information Section. This form is for US and Canadian Residents only. Please contact the Teva Learning Center for foreign registration.

If you have any questions, please contact seminar@tevacenter.org or (917) 805-8841

* First Name
* Last Name
Organization
* Address
Address (cont)
* City
* State (abbreviation)
* Zipcode
* Email Address
Phone Number (digits only please)

Participant Information

Please fill out the following form with the information for the participants from your organization. Please contact Teva if you would like to bring more than 6 participants.

Select number of participants:
There is a $50 discount for each additional person

Note Regarding Tracks:

	* First Name	* Last Name	* Age	* Gender	* E-mail	* Room Type	* Track
1.
2.
3.
4.
5.
6.

	*In Case of Emergency Please Contact:
* Emergency Contact:
* Relationship:
* Contact Phone#1
Contact Phone#2
Do your participants have any allergies to food or medication? Please be specific
Do your participants have any special dietary needs? (All meals will be vegetarian)
Do your participants have any other medical concerns that may limit their ability to participate during the seminar?
Please be in touch with me about train information from NYC to the Seminar I would like information about carpooling with others from my area. It is possible I will need to arrive Sunday evening and/or leave Friday morning. Please be in touch with me about those options and costs.

Payment

I’d like to help other people attend the Teva Seminar.
* Name on the Credit Card
* Type of Credit Card	Visa Mastercard
* Credit Card Number	(use xxxx-xxxx-xxxx-xxxx format)
* Expiration Date (mm/yyyy)	/
* Zip Code on Credit Card Statement
* Amount Outstanding
* Amount to be Charged
* Payment Amount	Pay Non-refundable Deposit of $100.00 per person and receive a bill for the remainder. Pay Full Amount of
*How did you hear about the seminar? Please be specific
	CLICK TO SUBMIT REGISTRATION Upon review of your registration information, you will recieve a confirmation, including driving directions and a packing list.

Seminar Information:

Teva Seminar on Jewish Environmental Education

June 2th-June 5th, 2008

Surprise Lake Camp