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ENROLLMENT FORM
YES! I want to join VBS Hazak
My name is: _________________________________________
Address: ____________________________________________
Phone (______)_______________________________________
E-Mail: _____________________________________________
 Member of a
Synagogue
Which one? _________________________________________
Annual Dues:
VBS Members - $18.00 Non-members - $36.00
OPTIONAL
Please tell us about yourself
Skills,
Hobbies, Interests:
___________________________________________________
___________________________________________________
___________________________________________________
I
am available to drive others to HAZAK programs.
I am working:
Full Time
Part Time
Retired
Profession/Occupation:
___________________________________________________
These programs/activities
interest me most:
___________________________________________________
___________________________________________________
___________________________________________________
Please make check payable to Valley Beth Shalom
and return with this form to:
Valley Beth Shalom Hazak
15739 Ventura Blvd., Encino, CA 91436
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