Cycle 6 Teleconference Registration

Tznius Teleconference Registration Form - Cycle 6

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Would you like us to send you the book we will be learning together (Daughters of Dignity) in the mail for $18? *

Yes, I will submit payment via PayPal. Yes, I will submit payment via check. Yes, but I cannot afford to pay at this time. Yes, and I'd like to sponsor another book for someone else to learn as well. No, I already have the book No, I prefer to call in to listen without the book.

Address (for study materials to be sent) *

Line 1

Line 2

City

State

Zip Code

Country

Davening Name (Your Full Hebrew Name) *

How did you hear about this program? *

EX: Sarah Rivka b-s Rochel Leah

Marital Status: *

Age Range *

Birth Year *

Occupation *

Which seminary did you go to? *

In the zchus of my learning, may Hashem speedily send the right zivug to everyone in the Future Kallahs Tehillim Team and to:
EX: Moshe Pipick (uncle) - Moshe b-n Ploni *

If you would also like to dedicate your learning in honor of, in memory of, or for the refuah of a loved one you may also write your dedication in the box below. *

In submitting this form I understand that I am committing to learn (b'li neder) on behalf of the names above and I will report the engagements of each name I submit to [email protected].

Count me in!