Tot Shabbat Book Club Registration Parent's Name* First Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Number of Children Attending*Name of Child 1* Birthdate of Child 1* MM slash DD slash YYYY School Child 1 Attends* Name of Child 2 Birthdate of Child 2 MM slash DD slash YYYY School Child 2 Attends Name of Child 3 Birthdate of Child 3 MM slash DD slash YYYY School Child 3 Attends Is this the first time you have attended an event at Mirowitz?* Yes No How did you hear about Mirowitz's Tot Shabbat Book Club?* Facebook Instagram A friend Email Other (explain below) Explain here: Are you interested in learning more about Mirowitz?* Yes! No, thanks. Are you interested in learning more about PJ Library?* Yes! I already receive PJ Library books! No thanks! I am interested in events for Hebrew speakers.* Yes! No thanks!
