2025 Pre-Benei Mitzvah Retreat Registration Form

Parent #1 Information

Parent #1 Name *

First

Last

Parent #1 Email *

Parent #1 Phone *

Parent #2 Information

Parent #2 Name *

First

Last

Parent #2 Email *

Parent #2 Phone *

Name(s)/Grade(s) of kids attending

How many vegetarians dishes? Enter NA if not applicable *

How many gluten free dishes? Enter NA if not applicable *

How many dairy free dishes? Enter NA if not applicable *

List any food allergies if any. Enter NA if not applicable *

Total Number of People Attending (include all adults and children in attendance) *

Payment Information

Payments may be made by check payable to Congregation Beth Shalom or credit card by calling Amira, 412-421-2288 x110, or through PayPal or credit card online here. Thank you!

Family - $360 per family *

Would You Like to Make an Additional Donation?

A donation above the subsidized price will ensure our being able to make this retreat possible for other families like you.

Yes, I would like to donate to the retreat.

Other Donation Amount

Please enter your other donation amount above.

Total Amount

$0.00

Payment Method *

Pay with PayPal
Pay with Check*
Bill My Account

*Please make check payable to Congregation Beth Shalom. Mail check to: 5915 Beacon Street, Pittsburgh, PA 15217