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JLI Registration Form

JLI Registration Form

Registration Form

Mr. Mrs. Ms. Dr. Atty. Rabbi

*Name (First & Last):

* Address:

City, State, Zip: *

Day Phone: *

Evening Phone:

Email Address: *

How did you hear about this course?

What questions do you hope to learn about in this series?

Other Subjects You Would Like To See Offered:

Comments / Other Areas of Interest:

Chabad's policy is that no one will be turned down due to lack of funds
For other options please call Rabbi Shaya at 860-232-1116 or email

Pay by Credit Card

Credit Card Info:
First Name:
Last Name:
City, State and Zip:
Credit Card Number:
Exp. Date: (mm/yyyy)
CSV #:

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I will be sending in payment
[Please send to:
Jewish Learning Institute
2352 Albany Avenue, West hartford CT 06117

Please call me to discuss options



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