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0 1 2 3 4 5 6 7 8 9 10	Attending $36.00 Each
	Thank you for your interest in joining us for the 2021 Tour De Shushan Purim "Car"-nival!! Please take a moment to complete this registration form so we can collect all the proper information. Confirmation emails will be sent after registration form has been received and reviewed. Any questions? Contact Josh Ackman at Educator@rsholom.org or (813) 837 -1911 * Full Name of person completing registration form * Phone number of person completing the registration form This will not be shared with anyone, but used for any questions regarding registration or contact during the program * Email address of person completing form * Are you a member of a synagogue? If yes, please let us know which synagogue. If not, please type "no" * How many members of your family will be on your "team"? *Due to CDC guidelines, please keep your team to your immediate family members * Make and Model of the car you will using for the program Person 2 Full Name Person 2 Phone number Person 2 Email Address Person 2 shirt size Person 3 Full Name Person 3 Phone number Person 3 Email Address Person 3 shirt size Person 4 Full Name Person 4 Phone number Person 4 Email Address Person 4 shirt size Any additional members of your family joining? Please make sure to include all names and T-Shirt sizes Are there any additional concerns you would like us to be made aware of? Allergies, Medical conditions, etc. * Emergency Contact Name* *Please make this someone who will not be at the program * Emergency Contact Phone Number* *Please make this someone who will not be at the program
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