Civil Rights Trip

Are you a Temple Emanu-El member?

* Number of people you are registering for

* First Name

* Last Name

* Cell Number

Home Phone

* Address Line One

Address Line Two

* City

* State

* Zip Code

Roommate Request

Leave blank if none

* Bedding Preference

Dietary Restrictions

Kosher, vegan, vegetarian, gluten free etc. Please list all

Anticipated mode of transportation

Name of attendee #2

First and last

Cell Number of Attendee #2

Email of Attendee #2

I agree to pay $250 towards the deposit (single participant)

I agree to pay $500 towards the deposit (couple)

Sat, April 1 2023 10 Nisan 5783