Booking Form:

 

Name:*
Date of Birth*
 / 
 / 
E-mail Address:*
Mobile Phone*
Home Phone:
-
Address:
Reform Synagogue Member?
Synagogue Membership
Which Sixth Form / College do you attend?

Which workshops are you signing up for?

Students:
Parents Forum
Total:
Please keep me updated with future information about activities and events at the EHRS Youth Centre*
Type name and date as electronic signature

The next page will be the payment page.

You will now be taken to PAYPAL. You do not need to have a PAYPAL account.
We do not retain any credit card or payment information.
Please ensure that you complete your personal details as well as, if requested, type PREUNIVERSITYand your surname in the payment DESCRIPTION box to ensure that we can connect the booking with the payment when it appears in our bank account