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CGI Registration

CGI Registration

Camp Gan Izzy 2015 
Summer Day Camp Registration

Cheques payable to “Chabad House” to:
Chabad House
42 St. Georges Road
London SW19 4ED

Or pay via credit card below:

 

First Name:
Surname
Hebrew Name
Date of Birth
Address
Home Telephone
Mobile
Email
Other emergency number
Name of Doctor
Telephone of Doctor
Medical Info/Allergies


 Credit Card Payment:

 Visa   Mastercard
 Amount (£100, including lunch and all trips)
 Card Number
     Expiration Date

 

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