Sifriyat Pajama Registration

Name*
First Last
Address*
Street Address City State ZIP Code
Email*
Phone*
Number of Children Attending*
Please list the names and birthdates of your children:*
Name: Birthdate: Name of School Attending
How did you hear about this event?*
- Mirowitz Facebook Page
- A friend
- Email
- The Jewish Light
- I have attended previously
- My kids go to Mirowitz.
- Israeli Scouts
- ישראלים בסנט לואיס (Facebook page)
Is this your first time attending an event hosted by Mirowitz?*
- Yes
- No
Are you interested in learning more about Mirowitz?*
- Yes!
- No, thanks.

Name:	Birthdate:	Name of School Attending