From Gaza to Negotiations: The Role of American Jews
Brit Tzedek v'Shalom 3rd Annual Conference
Temple Israel of the City of New York
112 E. 75th Street New York, N.Y. 10021
Saturday through Monday, February 19-21, 2005
REGISTRATION FORM
(for a printable version click here)
(One registration per submission please)
Full Name
 
Address
Street:  City: 
State:  Zip Code: 
Phone Number Work:    Home: 
Email Address
Registration General Registration: (Pre-Conference rates until 2/18/05 at 5:00pm EST. Add $5 for on-site registration.)
 $100 Full Conference - Member
 $125 Full Conference - Non-Member (includes one year of membership)
 $50 Student Full Conference (includes one year of membership)
 $50 Low Income Full Conference - Member
 $60 Low Income Full Conference - Non-Member (includes a one-year membership)

Single-Day Registration:
$60 Member Sunday only
$50 Member Monday only
$70 Non-Member Sunday only
$60 Non-Member Monday only
$30 Student/Low-Income Day Rate

Sunday Evening Dinner:
$25 Open to those who have registered for the full conference or Sunday only
Dinner and discussion with workshop presenters and fellow attendees. Vegetarian options will be available.
Evening Plenaries:
 $10 (suggested donation)
Payable at the door only
Registration fees include all public sessions only.  
Credit Card VISA       MASTER CARD
Name on Credit Card
Card Number
Expiration Month:   Year:  
Payment I wish to make an additional contribution of $  to help subsidize student and low-income registrations.

$   (charged to your credit card)

(Registration Fees are non-refundable)
        
When you click "send", this secure form is faxed to our national office for manual processing. Your financial information is not stored on the Internet. If you are concerned with the security of a transaction of this sort, you may print out this form, and fax (312) 341-1206 or mail it, or call us on the phone to register during business hours.

Brit Tzedek v'Shalom, the Jewish Alliance for Justice and Peace - 11 E. Adams, Suite 707 - Chicago, IL 60603
Ph: (312) 341-1205 - Fax: (312) 341-1206 - info@btvshalom.org