Hillel Council of New England · Shabbat of Love Havdalah Program Registration Form

Contact Information

Name

*

First Name

Last Name

Email

*

Verify Email

*

Cell Phone

*

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

I am a

*

Current Undergraduate Student

Current Graduate Student

Alumni

Family Member (Current Student)

Family Member (Alumni)

Family Member (Israel Program Participant)

Faculty/Staff

Community Member

Prefer Not to Disclose

Please list your student's name and year of graduation

Please list your year of graduation

Campus Affiliation (if applicable)

Bentley University

Boston College

Curry College

Emerson College

Lesley University

Simmons University

Suffolk University

Other

Program Options

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Please select which Shabbat of Love Havdalah program option works best for you:

I plan to host a gathering.

I plan to join a gathering taking place on a campus in the Boston area.

I plan to participate on my own.

Program Options, Continued

Please select which Boston area campus gathering you would like to join (NOTE: we cannot guarantee all campuses will be holding a gathering but will do our best to accommodate your request):

Bentley University

Boston College

Emerson College

Simmons University

Please list your campus affiliation