DOWNLOADABLE FORM!

USY Fall Sub-Regional Convention

October 10 -12, 2008

Staff Application

Please fill out a separate form for each staff member attending.

Name_______________________________________________

Chapter______________________________________________

Cell Phone # _________________________________________

Are you a vegetarian?  Yes___________                   No__________

Check one:

Staff is allowed to stay in their own home only if they live in adjacent communities.

Adjacent Communities include: Cooper City, Pembroke Pines, Plantation, Hollywood, Davie and Southwest Ranches

_____          I will make my own housing arrangements

_____          I will make a hotel reservation made at my own expense at the:

Reservation under Beth Ahm Israel

Hampton Inn – 1900 NW 150^th  Avenue Pembroke Pines

954-441-4242

                   $104 a night including breakfast

_____          I would like home hospitality.

I need to be within walking distance of the synagogue.  Yes_____ No_____

Cost: Staff Fee is $90 (this is for food and incidentals) Regional rules state that there must one advisor for every fifteen USYers.