.htm_cmp_Arctic000_hbtn.gif){kind=small}
Arvot Sub Regional Chapter Presidents Weekend
Sept 12 – 14, 2008
Hosted at BTBRC, Beth Torah Benny Rok Campus
Cost $90 (make checks payable to Beth Torah)
Deadline August 25th to Beth Torah Benny Rok Campus
Mail to Beth Torah Youth Department
Attn: Matt Oziel
20350 NE 26th Avenue NMB, FL 33180
Name ______________________________________ Chapter ___________
Address _______________________________________________________
City _____________ State ___ Zip _________
Gender _M _F Grade ___
Home Phone Number __________________ Email ____________________
USYer’s Cell___________________ ____________________________________________________
Parents’ Names _________________________________________________
Contact person in case of emergency (other than parent)
Name ____________________ Phone # ______________
Relationship ______
Sweatshirt Size __ S __ M __ L __ XL __ XXL
Check one:
__No __Yes Vegetarian? if yes will you eat chicken, eggs, fish (circle those that apply)
__No __Yes Walking Distance Required
__No __ Yes Any allergies and or/ restrictions? if yes, please list _________________
List 2 USYers you would like to room with, in order of preference:
1. Name __________________________________ Chapter __________________
2. Name _________________________________ Chapter __________________
Every effort will be made to honor mutual requests.
Requests will only be considered if forms are received on time.
WE have read the application and attached rules and regulations and the applicant agrees to abide by the rules of this convention.
WE understand that any infraction could result in being sent home from convention at your expense.
Applicant’s Signature ____________________________________ Date _____________________
Parent’s Signature ______________________________________ Date ________________________
For more information please contact Stephanie Nichol at the regional office 561-372-0420 or Nichol@uscj.org or
Arvot President Jake Winn jaketheactor@yahoo.com