2019-2020 Center for Jewish Engagement and Learning Registration Form General InformationName* First Last Birthday* MM slash DD slash YYYY Address* Street Address City State / Province / Region ZIP / Postal Code Email* Phone*Is this a cell phone?* Yes No Emergency Contact* First Last Emergency Contact Phone*Allergies or Medical Conditions we should be aware ofPlease answer this OPTIONAL question if you are comfortable I identify as Jewish I identify with a faith other than Judaism I identify with multiple faiths I identify with no faith Course SelectionPlease select the course(s) you are registering for:* Mussar: A Jewish Toolbox for life (young professionals) Mussar for Teens: Challenges and Choices: A Jewish Teen's Guide to a Balanced Life Middah of the Season: October 27, 2019 Middah of the Season: January 19, 2020 Middah of the Season: March 29, 2020 Middah of the Season: June 14, 2020 Living a Jewish Year (PJ Library Families) Living a Jewish Year (Adults Only) Season of Mussar I ($136 fee - pay TMI directly) Season of Mussar II ($136 fee - pay TMI directly) Wise Aging (Tuesday Evenings) Wise Aging (Wednesday Afternoons) Intro to Judaism (Semester 2 - $72 fee) Beginning Hebrew (Semester 1 - $175 fee) Beginning Hebrew (Semester 2 - $175 fee) Intermediate Hebrew (Semester 1 - $175 fee) Intermediate Hebrew (Semester 2 - $175 fee) Jewish Teen Leadership Fellowship ($390 fee) Women Gathering - Well Circle Women Gathering - Mussar for Moms Women Gathering - Becoming Women Gathering - Wise Women TuitionIntro to Judaism | Semester 2 Price: Beginning Hebrew | Semester 1 Price: Beginning Hebrew | Semester 2 Price: Intermediate Hebrew | Semester 1 Price: Intermediate Hebrew | Semester 2 Price: Jewish Teen Leadership Fellowship Price: Total $0.00 Billing Address Street Address City State / Province / Region ZIP / Postal Code Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Expiration Date Security Code Cardholder Name Product Name Quantity Price: $0.00 Quantity EmailThis field is for validation purposes and should be left unchanged.