First Name:      MI:     Last Name:

Address (line 1):

Address (line 2):

City:    State:    Zipcode:

Home Telephone #:
Work Telephone #:
Cell Telephone #:

Emergency Contact Name:    Telephone #:

E-Mail Address:

Male    Female

Date of Birth (mm/dd/yyyy):

Please check all that apply;
I am interested in reading torah.
I am interested in reading haftorah.
I am interested in leading services.

I would like to volunteer.

I will be driving to camp in my own car.
I will be driving to camp in my own car and can take others.
I will be taking the train to camp.

I will be bringing my bicycle.
I will be bringing my inline skates.
I will be bringing my guitar.

I am Shomer Shabbat.
I am comfortable rooming with people who are Shomer Shabbat.
I prefer to room with people who are Shomer Shabbat.

I usually attend egalitarian services.
I usually attend non-egalitarian services.
I usually do not attend services.

How did you find out about the weekend?
Email from
Newspaper advertisement in
Website:
From a friend:
Other:

Please tell us about yourself;
This will be my first Memorial Day Weekend at Camp Ramah.
I have attended previous Memorial Day Weekends at Camp Ramah (when? )
I was a camper at a Ramah summer camp (where?)
I worked on staff at a Ramah summer camp (where?)

We are intending to prepare a directory of participants to give out to attendees (please check one);
Please do not list me in any directory.
Please list me in the directory with my name only.
Please list me in the directory with my name and home phone number.
Please list me in the directory with my name and cell phone number.
Please list me in the directory with my name and email address.
Please list me in the directory with my name, home phone number and email address.
Please list me in the directory with my name, cell phone number and email address.

I am a vegetarian.

T-Shirt size:  small   medium   large  extra-large
-Please note that there is no guarantee that we will be able to give away T-shirts this year.

I am a group organizer and there are people in my group (not including me).
I am part of a group and the group organizer is

Room Type Request: Single   Double   Camper Cabin
Singles and Doubles are subject to availability. Please note that all rooms are non-smoking rooms.

Roommate Requests / Optional Message:

* Box below must be initialed (simply type your initials into the box on the next line):
To the fullest extent permitted by law, I, for myself and anyone entitled to act on my behalf, waive and release Camp Ramah in the Berkshires, Inc., Michael Brochstein, The National Ramah Commission, Inc., and the Jewish Theological Seminary, and their respective, past, present, and future members, directors, officers, employees, agents, and independent contractors and their successors, assigns and heirs from all claims or liabilities of any kind arising out of my participation in this event. I grant permission to all of the foregoing to use any photographs, motion pictures, or any other record of this event for any legal purpose. I realize that no environment is risk-free. I understand that part of the Camp Ramah in the Berkshires experience involves terrain, facilities, activities and group interactions that may be new to me, and that they come with uncertainties beyond what I may be used to dealing with at home. I am aware of these risks, and I am assuming them on my behalf. It is agreed that any dispute or cause of action arising between Camp Ramah and me or Michael Brochstein and me, whether out of this agreement or otherwise, can only be brought in a court of competent jurisdiction located in Dutchess County, New York, and shall be construed in accordance with the laws of New York State.

Promotion Code (if any):

Method of Payment:   credit card   PayPal    check    other

Payment: How much will your your payment be for? 

Please look through this form carefully to make sure you've
filled it in correctly before pushing the SUBMIT button.  Thanks!

Snail Mailer's: Click here to download a registration form for those using snail mail to register.

All registrations must be paid in full and received by Tuesday, May 20 at 6:00pm.