"Larger Than Life" Registration Form


REGISTRATION INFORMATION


First Name*: 
Last Name*:  
Email*: 
Phone Number*: 
Address*: 

City*:  State*:  Zip*: 

PAYMENT DETAILS

 $65 for the Full Course - Special discounted rate - Includes Student Book
$12 per class
$15 per Student Book (Student book is included in Full Course Registration)

# of attendees:* 

Total  = *

Payment by credit card:

Credit Card Number:
  (no spaces)

Expiration Date: Month  * Year  *

Security Code: 

I will pay by check. Please mail to
Chabad-HCW, 15 Edgfield Ave., Milford, CT  06460

Comments/Notes: 

*Denotes required field

 THANK YOU!