INSTRUCTIONS:

 1. Please answer all questions on this form, and for each registrant, indicate whether you are interested in home hospitality by circling Yes or No.

NOTE: Home hospitality will be offered to the first 20 attendees whose registration payments are received.  We will try to accommodate others in the order in which their forms arrive, as space allows.

2.  Make check or checks payable to Jewish Scholastic Press Association.

3.  Deadline is Monday, Oct. 6. EXTENDED TO OCT. 20.

4. Print out a paper copy of the form and mail it with check(s) for registration to:

Jewish Scholastic Press Association

c/o Shalhevet High School  

5901 W. Olympic Boulevard, Suite 108  Los Angeles, CA 90036

AFFILIATION:

Organization or school ____________________________________________________

Address  _____________________________________________________________

Telephone number ______________________________________________________

Fax number _______________________

Name and title of chaperone or adviser  ________________________________________

Contact info for chaperone or adviser E-mail ____________________________________

Cellphone  ____________________________________________________________

Publication name:  _______________________________________________________

Website URL and/or other social media: ________________________________________

____________________________________________________________________

Delegates, including adviser if applicable, @ $125 each.  Includes catered Shabbat dinner and lunch.

1. Student  ___________________    Position ______________                                       Hospitality?           yes         no
2. Student  ___________________    Position ______________                                       Hospitality?            yes         no
3. Student  ___________________    Position ______________                                       Hospitality?            yes         no
4. Student  ___________________    Position ______________                                       Hospitality?            yes         no
5. Student  ___________________    Position ______________                                       Hospitality?            yes         no
6. ADVISER (required for 4 or more students) _____________________________     Hospitality?            yes         no

Total due with registration:  $____________________