REGISTRATION Hebrew Reading Crash Course October 10 - November 14, 2012 Personal Information: First Name: Last Name: Email: Additional guest in your party: We're old friends -You have my information!(skip next section) Address: City: State: Zip: Phone No: Fee: In advance by 9/28: $90 0 1 2 3 4 5 6 7 8 9 In advance by 9/28 - Student: $45 0 1 2 3 4 5 6 7 8 9 After 9/28: $105 0 1 2 3 4 5 6 7 8 9 After 9/28 - Student: $60 0 1 2 3 4 5 6 7 8 9 Payment Information: Card Type: Please select MasterCard Visa American Express Discover Name on Card: Card No: CVV Security Code: What's This? Expiration Date: Month 01 02 03 04 05 06 07 08 09 10 11 12 Year 2012 2013 2014 2015 2015 2016 1017 2018 2019 2020 Total Amount: Comments: Enter any extra details here. This page uses 128 bit SSL encryption to keep your data secure.