Be a Visionary. Be a Leader. BE CONNECTED.

Welcome to on-line registration for the KESHER Leadership Council's Leadership Training Seminar

Registrant Information

First Name *

  MI

Last Name *

Date of Birth *

College/University Name *

Graduation Date *

Year 2007 2008 2009 2010 2011 2012 2013 Semester Fall Spring Summer

How would you like your First name to appear on your nametag?

T-Shirt Size

S M L XL

Instant Messenger Name:

Service: Please select AOL Instant Messenger MSN Messenger Yahoo! Messenger

Gender:

Female    Male Prefer Not To Disclose

School Address

Address Line 1*

Address Line 2

Apartment/Room No. *

City *

State/Province *

-- AB AK AL AR AZ BC CA CO CT CZ DC DE FL GA GU HI IA ID IL IN KS KY LA LB MA MB MD ME MI MN MO MS MT NB NC ND NE NF NH NJ NM NS NT NV NY OH OK ON OR PA PE PQ PR RI SC SD SK TN TX UK UT VA VI VL VT WA WI WV WY    Zip Code *  

Phone

Cell Phone *

Preferred E-mail *

Permanent Address

Address *

City *

State/Province *

-- AB AK AL AR AZ BC CA CO CT CZ DC DE FL GA GU HI IA ID IL IN KS KY LA LB MA MB MD ME MI MN MO MS MT NB NC ND NE NF NH NJ NM NS NT NV NY OH OK ON OR PA PE PQ PR RI SC SD SK TN TX UK UT VA VI VL VT WA WI WV WY    Zip Code *  

Leadership position at Hillel/KESHER Reform Chavurah If applicable

KESHER President	KESHER Board Member: Specify	Worship Leader
Hillel President	Hillel Board Member: Specify	Other: specify
	I am a Reform Jewish Liaison for my Campus

Tell us about your involvement

Is this your first KESHER Event? *

Yes

No

How did you hear about Leadership Training Seminar? *

Please check the programs you have participated in:

Leadership Training Seminar

Birthright Israel with KESHER

Birthright Israel with another organization

KESHER@Biennial

KESHER Convention

Argentina Ambassadors

Alternative Break Program

Other:

Do you have any special needs

Do you have any special needs with which we can assist you at the Convention?

Vegetarian

Dietary - Please explain   

Other Special Needs:   

Housing

Please tell us about your housing needs:

I am requesting hospitality housing.

Roommate Requests:

I live in the Austin area and can house one or more participants.

How many participants can you accommodate?

I do not need any form of housing and cannot offer home hospitality.

Select Participation Rate

Early Bird Registration	Fee: $55.00 (Registration before February 27, 2008)
Regular Deadline	Fee: $65.00 (Registration by March 12, 2008)

We understand that many participants will be receiving scholarships from various sources. For this reason, partial payments (by Check ONLY) will be accepted. However, participants will not be fully registered until complete payment is received in our office. Only indicate scholarship funds if they are being sent directly to LTS (not if you are being personally reimbursed). We must receive payment or written confirmation of all financial assistance by March 14, 2008. Please make all Checks out to: University of Texas Hillel, and put KESHER LTS in the MEMO and send them to:
UT-Austin Hillel
Attn: KESHER LTS
2105 San Antonio Street
Austin, TX 78705-5521
	I am receiving financial assistance from my campus Hillel.	Amount:
	I am receiving financial assistance from my home congregation.	Amount:
	I am receiving other financial assistance.	Amount:
	Source:

Please Read!!

“The KESHER Student Leadership Council's Leadership Training Seminar is a student-conceived, student-planned, and student-run event, which is supported by the Union for Reform Judaism's KESHER College Department. Your registration information, including, but not limited to, your payment information, e-mail address, home and school mailing address and phone numbers, will be maintained by the students planning this event and not the URJ KESHER College Department. Limited Contact Information may be shared with co-sponsors.”

Please do not give my information to the KESHER College Department for the KESHER mailing list.

I would like to be listed in the KESHER Directory and at www.keshernet.com so Reform Jewish High School students can contact me about life on my campus.