Name: Winter 2022-2023 Birthright Israel Orientation #1
Start: 2022-12-01T19:00:00-05:00
End: 2022-12-01T20:00:00-05:00

Have you signed up for any Maryland Hillel events this year?(Required)

Yes

No

Student Information

Student Name(Required)

First Last

Mobile(Required)

Email(Required)

UMD Student ID(Required)

Greek Affiliation (if applicable)

What city and state are you moving to after graduation?

No problem if you don't know!

Are you able to help out with senior events?(Required)

Yes

No

Are there other students you think could be interested in this event? Please list their name and email address:

Thank you in advance for filling out this long questionnaire. After signing up today we are hoping you will not be asked to fill out this much information again!

Student Information

Student Name(Required)

First Last

Personal Email(Required)

Mobile Phone Number(Required)

UMD Student ID(Required)

What city and state are you moving to after graduation?

No problem if you don't know!

Are you able to help out with senior events?(Required)

Yes

No

Are there other students you think could be interested in this event? Please list their name and email address:

Background Information

High School(Required)

Jewish Summer Camp (if applicable)

Religious Affiliation(Required)

Jewish - Reconstructing Judaism

Jewish - Reform

Jewish - Conservative

Jewish - Orthodox

Jewish - Just Jewish

Not Jewish

Greek Affiliation (if applicable)

Youth Group (If applicable)

Parent 1 Information

REQUIRED

Parent 1 Name(Required)

First Last

Parent 1 Email(Required)

Parent 1 Mobile(Required)

Home Address (if different than student's)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent 2 Information

Parent 2 Name

First Last

Parent 2 Email

Parent 2 Mobile

Home Address (if different than student and Parent 1)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

CAPTCHA

Winter 2022-2023 Birthright Israel Orientation #1

December 1, 2022

Student Information

Thank you in advance for filling out this long questionnaire. After signing up today we are hoping you will not be asked to fill out this much information again!

Student Information

Background Information

Parent 1 Information

Parent 2 Information

Contact Information

Winter 2022-2023 Birthright Israel Orientation #1

December 1, 2022

Student Information

Thank you in advance for filling out this long questionnaire. After signing up today we are hoping you will not be asked to fill out this much information again!

Student Information

Background Information

Parent 1 Information

Parent 2 Information

Contact Information

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