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
FEBRUARY 19-21, 2005

REGISTRATION FORM (Registration on Site only.)
Full Name
_____________________________________
Address
Street: ________________________________ City:
__________________________
State: ____________________ Zip Code: ___________________
Phone Number Work: _______________________   Home:  _________________________
Email Address _______________________________________
Registration General Registration:
___ $105 Full Conference - Member
___ $130 Full Conference - Non-Member (includes one year of membership)
___ $55 Student Full Conference (includes one year of membership)
___ $55 Low Income Full Conference - Member
___ $65 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.

Total amount to be charged to your credit card:  $ ____________________
(Registration Fees are non-refundable)
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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