The cost for the trip is $315

Name on Credit Card:

Credit Card: (Extra 3% charge for AMEX) Other:

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Amount to charge:

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Your name (if different than on credit card):

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Does your son have somewhere to stay in Crown Heights?

If you live in Crown Heights, are you in a position to accomodate any extra bochurim for the duration of the trip:

Please share with us any other thoughts or concerns you may have about the trip: