JLI Reservation Form Contact Information Title Please select Mr. Mrs. Ms. Miss. Dr. Rabbi First Name Last Name Address Email Participant number 2 Title Please select Mr. Mrs. Ms. Miss. Dr. Rabbi First Name Last Name Address Email Participant number 3 Title Please select Mr. Mrs. Ms. Miss. Dr. Rabbi First Name Last Name Address Email Programs I would like to attend Fascinating Facts I would like to make a donation to JLI I will be attending the following program: Chabad House Savoy Chabad in the Mall Beginning 8 November 2011 Beginning 9 November 2011 Tuesday Course Wednesday Course 9:30am 7:30pm Fascinating Facts Fascinating Facts Instructor Rabbi Ari Kievman Instructor Rabbi Ari Kievman Cost R199 CostR250 Chabad of Gallo Manor Beginning 8 November 2011 Tuesday Course 7:30pm Fascinating Facts Instructor Rabbi Shauli Minkowitz Cost R250 Payment Total Amount Card Type Please Select Visa Mastercard Amex Card Number Exp. Date CVV code Comments This page uses 128 bit SSL encryption to keep your data secure.
