ECJS

Family Name:	*
First Name:	*
Birthday:	*
Address:	*
City:	*
Country:	*
		Other:
Gender	*
E-mail address	*
Phone Number:	*
Mobile Number:	*
Preferences for roommate : (maximum 4 people per room)
Do you have any special dietary requests (vegetarian, etc...)?
When will you be arriving?		:
How will you be arriving?
When will you be leaving?		:
Are you using the same transportation for your return?		yes no
Comments
How did you hear about us?
Did you ever take part of a Jewish event?

Please note that the registration will be effective only when we receive the full payment (€200) to our bank account.

I hereby acknowledge and agree to the conditions of E.C.J.S. concerning the New Years weekend venue 2004-2005 in Vienna, Austria.