Jewish National Fund - Survey - TU BISHVAT ACROSS AMERICA REGISTRATION FORM

Thank you for your interest in celebrating Tu BiShvat Across America! Please fill out the information below to request a speaker.

*1.

Question - Required - Congregation/Organization Name

*2.

Question - Required - Congregation/Organization Street Address

*3.

Question - Required - Congregation/Organization City

*4.

Question - Required - Congregation/Organization State

*5.

Question - Required - Congregation/Organization Zip Code

*6.

Question - Required - Congregation/Organization Phone Number

7.

Question - Not Required - Congregation/Organization Website Address

*8.

Question - Required - Contact Person's Name

*9.

Question - Required - Contact Person's Title

*10.

Question - Required - Contact Person's Email Address

11.

Question - Not Required - Contact Person's Phone Number (if different than above)

*12.

Question - Required - Congregation/Organization Affiliation (select one response)

*13.

Question - Required - Date of Tu BiShvat Program

*14.

Question - Required - Type of Tu BiShvat Program (select as many as you'd like)
Please make between 1 and 4 selections from the choices below.

15.

Question - Not Required - If you chose "Other" please specify here

16.

Question - Not Required - Are you interested in having a free speaker for your Tu BiShvat program?

17.

Question - Not Required - Name of speaker interested in:

18.

Question - Not Required - If you would like to receive free JNF Blue Boxes let us know how many.

19.

Question - Not Required - Topics you are interested in the speaker discussing:

(Maximum response 255 chars, approx. 5 rows of text)

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