Mizrachi - Religious Zionists of Chicago

MIZRACHI RZC - APPLIED ALIYAH SESSION 1 REGISTRATION FORM

Prefix

First Name *

Last Name *

Email *

Phone

Profession Type *

Physician
Dentist
Speech Therapist
Occupational Therapist
Physical Therapist
Psychologist
Nurse
Other Medical Professional

Medical Specialty

Registration *

I will attend Tuesday Evening, March 22, 2022 At 8:00 pm at the home of Dr. Oren & Jill Lakser, 9024 Sleeping Bear Rd. , Skokie

Number Attending (Spouses are welcome) *

1
2

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