DEADLINE IS JANUARY 4, 2017

INSTRUCTIONS:

1. Please answer all questions on this form, and for each registrant, indicate whether you are requesting home hospitality by circling yes or no next to each student’s name.

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

3. Home hospitality deadline is Monday, Dec. 12.  Conference registration must be received by that date to guarantee home hospitality.

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

Jewish Scholastic Press Association

Shalhevet High School

910 South Fairfax Ave.

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, @ $130 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: $____________________