Student Info

Name*

First Name Last Name

Phone*

Area Code Phone Number

E-mail*

Address* After Graduation

Birthdate*

Month Day Year

Major*

Parents Info:

Father’s Name*

First Name Last Name

Father’s E-mail*

Father’s Phone*

Area Code Phone Number

Mother’s Name*

First Name Last Name

Mother’s Phone *

Area Code Phone Number

Mother’s E-mail*

I am attending* Check all that apply

I am attending with:*

Total # of people attending*

I am lodging at:

Friends at UFHotelAirbnb

Comments or questions:

Meals and program is being offered free of charge. Donations are encouraged and greatly appreciated to help cover the costs.

Donation Amount

Dedications

I would like the Rabbi to contact me/us regarding a plaque dedication and gift in honor of graduation.

Payment

Credit Card Paypal Check/Venmo/CashApp/Zelle

Postal / Zip Code

Country

Please mail your check to: Lubavitch Chabad Jewish Center, 2021 NW 5th Ave. Gainesville, FL 32603