DOWNLOADABLE FORM!

Ein Gedi Sub Regional Chapter Presidents Weekend

Sept 5- 7, 2008

*Convention begins Friday at 4:30pm and ends Sunday at 12pm

Hosted at BUSY, Beth El, Birmingham

Cost $110(make checks payable to Beth El)

Deadline August 22nd to Beth El

Mail to Beth El Youth Department

Attn: Raya Rzeszut

2179 Highland Ave

Birmingham, AL 35205

Name ______________________________________ Chapter ___________

Address _______________________________________________________

City _____________State ___Zip _________ Gender _M _F Grade ___

Home Phone Number __________________ Email ____________________

USYer’s Cell Phone ___________________________________________

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

• For Chapter Presidents Weekend we try to place all delegates in walking distance to experience a true USY Shabbat

__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