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ב"ה

Programs Winter Program Registration

Jewish Disability Awareness

Yes, send me an at home as part of SHABATTOGETHER- Friday February 12th
Full Name
First NameLast Name
Cell
Area CodePhone Number

Address for Kit to be delivered to

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Payment
$36$180

Credit Card Venmo or Check

Postal / Zip Code

Country

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