online convention applications >> Sprinter >> tzafon usy online

Sprinter 2007!

Please note that an email address is required for online applications. Signup is not complete until payment, medical release, and code of conduct are recieved. Also please do not use commas to seperate things. Instead please just leave a space. Thank you.
Sprinter is Feb 8-10. The deadline to sign up is January 25th.
The cost is $170; $150 for TI and Ohav members ONLY.

Applicant Info:

First name:
Last name:
Gender:
Birthday:
Grade:
Street Address:
City:
State:
Zip:
Phone #:
Parent's E-mail:
Chapter:
2006-07 Dues Paid?:
First Convention?:
Email address:
AIM Screen-name:
If you were an animal what kind of animal would you be?:
What is your favorite part about USY?

Mother & Father / Guardian

Mother & Father / Guardian:
(Mother & Father / Guardian)'s home phone:
(Mother & Father / Guardian)'s cell phone:

Emergency Contact

Emergency name (not parent):
Emergency's cell phone:

Please Check Those Parts Of The Service You Would Like To Lead:

Weekday Sacharit:	Weekday Mincha:	Weekday Ma'Ariv:	Kabbalat Shabbat:
Weekday Ma'Ariv:	P'Sukai D'Zimrah:	Torah Service:	Torah Reading:
Haftorah:	G'Lilah:	Aliyah:	Birkat Hamazon:
Prayer For Israel Hebrew:	Kiddush Sat. Lunch:	Shabbat Mincha:	Shabbat Ma'Ariv:
Page Calling:	Gabbai:	Shabbat Sacharit:	Shabbat Musaf:
Hamotzi:	Hagbah:	Hallel:	I Am a:
Kiddush Fri. Night:

Remember:

All males must bring kippot, tallit, and tefillin. Females who wish to bring these items are encouraged to do so.

Rooming Preferences: Please only list three any more will be discarded. Co-ed housing is not avalible.

1.
2.
3.

Medical Info:

Vegetarian: Vegan: Fish:

Specify any food or other allergies:
Health Insurance Co:
Insurance #:
Name of Insured:
	If your child has any medical problem (s) we should be aware of please include a note with the written medical release that you will download on the next page.
Special Needs:
Allergies:
Allergies to medicine:
Current med:
Reason for taking:
Name of Doctor:

Please Note that you have to download and print the medical release form, code of conduct, and send payment to Tzafon USY 113 New Krumkill Rd, Albany, NY, 12208. All of this will be on the next page that you will see when you push that button!

By clicking the below button, you are registering for Sprinter Kallah. Cancellations MUST be received in writing and are subject to a $100 cancellation fee after February 1. No refunds will be made after February 4, 2008. If notification of your cancellation of attendance, regardless of mode of application submission, is not received in accordance with the cancellation policy, you will be billed.